Basic Information
| Provider Information | |||||||||
| NPI: | 1356481642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMULADA | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24422 AVENIDA DE LA CARLOTA STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926533628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495992434 | ||||||||
| FaxNumber: | 9495992430 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 CORPORATE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | LADERA RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926942179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493477200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A43964 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 371528291 | 01 | CA | TAX ID | OTHER |