Provider Demographics
NPI:1942314018
Name:MULLICAN, CHRISTINA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2865 COTTAGE CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-6913
Mailing Address - Country:US
Mailing Address - Phone:951-684-8020
Mailing Address - Fax:951-684-8090
Practice Address - Street 1:4440 BROCKTON AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3901
Practice Address - Country:US
Practice Address - Phone:909-684-8020
Practice Address - Fax:951-684-8090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15077363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics