Basic Information
| Provider Information | |||||||||
| NPI: | 1023013224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITTARD | ||||||||
| FirstName: | CHRISTA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1856 E INNOVATION PARK DR | ||||||||
| Address2: | |||||||||
| City: | ORO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857551963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208257111 | ||||||||
| FaxNumber: | 5208181253 | ||||||||
| Practice Location | |||||||||
| Address1: | 1856 E INNOVATION PARK DR | ||||||||
| Address2: | |||||||||
| City: | ORO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857551963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208257111 | ||||||||
| FaxNumber: | 5208181253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 31450 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.