Provider Demographics
NPI:1477840064
Name:GARVIN, CHRISTINA MONIQUE (DPM)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MONIQUE
Last Name:GARVIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MONIQUE
Other - Last Name:LUCERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 E STATE HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2134
Mailing Address - Country:US
Mailing Address - Phone:209-223-7040
Mailing Address - Fax:
Practice Address - Street 1:820 E STATE HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2134
Practice Address - Country:US
Practice Address - Phone:209-223-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000749213ES0103X
CAE5481213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO373859YWPAMedicare UPIN