Provider Demographics
NPI:1891738142
Name:CHRISTINE E. DAHLIN, M.D. INC.
Entity Type:Organization
Organization Name:CHRISTINE E. DAHLIN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-374-1333
Mailing Address - Street 1:375 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1023
Mailing Address - Country:US
Mailing Address - Phone:805-374-1333
Mailing Address - Fax:805-374-1323
Practice Address - Street 1:375 ROLLING OAKS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1023
Practice Address - Country:US
Practice Address - Phone:805-374-1333
Practice Address - Fax:805-374-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G84455OtherPRIVATE INSURANCE PIN
CA00G844550OtherBLUE SHIELD
CA00G844550OtherBLUE SHIELD
WG84455AMedicare PIN
=========OtherEIN
P00247037Medicare ID - Type UnspecifiedRAILROAD MEDICARE
G84455OtherPRIVATE INSURANCE PIN
W18468Medicare ID - Type UnspecifiedMEDICARE GROUP