Provider Demographics
NPI:1891880142
Name:WIGEN, CHRISTINE L (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:WIGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 S GRAND AVE
Mailing Address - Street 2:ROOM 500
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2608
Mailing Address - Country:US
Mailing Address - Phone:213-744-3070
Mailing Address - Fax:
Practice Address - Street 1:2615 S GRAND AVE
Practice Address - Street 2:ROOM 500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2608
Practice Address - Country:US
Practice Address - Phone:213-744-3070
Practice Address - Fax:213-749-9606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67851207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A678510Medicaid
CAA67851Medicare ID - Type UnspecifiedMEDICARE PROVIDER#
CAH61957Medicare UPIN