Provider Demographics
NPI:1770796708
Name:COLE, CHRISTINE M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:COLE
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 1:267 W HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4211
Mailing Address - Country:US
Mailing Address - Phone:805-497-1694
Mailing Address - Fax:805-373-7493
Practice Address - Street 1:267 W HILLCREST DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-497-1694
Practice Address - Fax:805-373-7493
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40609207N00000X
CAA119802207ND0900X, 207N00000X
PAMD444035207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ354255Medicaid
CAP01125198OtherRAILROAD MEDICARE
CAGK137ZMedicaid
AZP00623799OtherRAILROAD MEDICARE