Provider Demographics
NPI:1356410740
Name:THEARD, CHRISTINE MARIE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:THEARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30131 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE # 237
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-495-0800
Mailing Address - Fax:949-495-0805
Practice Address - Street 1:30131 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE # 237
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-495-0800
Practice Address - Fax:949-495-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC50353207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50353OtherSTATE LICENSE NUMBER
CAWC50353AMedicare UPIN