Provider Demographics
NPI:1992854780
Name:MILLARE, CHRISTINE ANNE (PA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:MILLARE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-5154
Mailing Address - Fax:
Practice Address - Street 1:415 OLD NEWPORT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4252
Practice Address - Country:US
Practice Address - Phone:949-548-9611
Practice Address - Fax:949-548-9958
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010530363A00000X
CA1066480363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant