Provider Demographics
NPI:1760545321
Name:LAWRENCE, CHRISTIE YBARRA (NONE)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:YBARRA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:MS
Other - First Name:CHRISTIE
Other - Middle Name:YBARRA
Other - Last Name:OYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AOD CERT
Mailing Address - Street 1:2115 CELESTE DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2616
Mailing Address - Country:US
Mailing Address - Phone:209-517-8813
Mailing Address - Fax:
Practice Address - Street 1:1111 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1305
Practice Address - Country:US
Practice Address - Phone:209-938-0228
Practice Address - Fax:209-938-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39-07261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center