Provider Demographics
NPI:1013126044
Name:BAWA, CHRISTIN ROSE (ATC, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:ROSE
Last Name:BAWA
Suffix:
Gender:F
Credentials:ATC, PA-C
Other - Prefix:MS
Other - First Name:CHRISTIN
Other - Middle Name:ROSE
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, PA-C
Mailing Address - Street 1:4060 4TH AVE, 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-686-8313
Mailing Address - Fax:
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-686-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0013072255A2300X
CAPA21934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer