Provider Demographics
NPI:1932145620
Name:CHRISTENSEN, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E. CHURCH STREET
Mailing Address - Street 2:ATTENTION: MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455
Mailing Address - Country:US
Mailing Address - Phone:805-739-3954
Mailing Address - Fax:805-739-3060
Practice Address - Street 1:877 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449
Practice Address - Country:US
Practice Address - Phone:805-474-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81578207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050359CG49067OtherTULARE TRAILBLAZER
CA00G815780OtherCALOPTIMA
CA00G815780OtherBLUE SHIELD
CAP00250832OtherTULARE RAILROAD
CAG81578OtherBLUE CROSS
CA00G815780Medicaid
CAP00250832OtherTULARE RAILROAD
CA00G815780OtherCALOPTIMA
CA00G815780OtherBLUE SHIELD
CABC797ZMedicare PIN
CAG81578OtherBLUE CROSS