Provider Demographics
NPI:1740545797
Name:HENDRICKSON, CHRISTY (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:
Last Name:HENDRICKSON
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 1:734 SEABRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1271
Mailing Address - Country:US
Mailing Address - Phone:858-755-2215
Mailing Address - Fax:858-755-2215
Practice Address - Street 1:734 SEABRIGHT LN
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1271
Practice Address - Country:US
Practice Address - Phone:858-755-2215
Practice Address - Fax:858-755-2215
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40036207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine