Provider Demographics
NPI:1740338540
Name:TAFT, CHRISTINE P (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:P
Last Name:TAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27699 JEFFERSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2661
Mailing Address - Country:US
Mailing Address - Phone:951-252-8588
Mailing Address - Fax:951-252-8589
Practice Address - Street 1:521 E ELDER ST
Practice Address - Street 2:101
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3081
Practice Address - Country:US
Practice Address - Phone:760-723-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51111208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG51111OtherSTATE OF CALIFORNIA