Basic Information
Provider Information
NPI: 1821198771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLE
FirstName: CHRISTINE
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 54433 FILE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900740001
CountryCode: US
TelephoneNumber: 8587845767
FaxNumber: 8587845933
Practice Location
Address1: 10820 N TORREY PINES RD
Address2:  
City: LA JOLLA
State: CA
PostalCode: 920371036
CountryCode: US
TelephoneNumber: 8585543300
FaxNumber: 8587845933
Other Information
ProviderEnumerationDate: 09/22/2006
LastUpdateDate: 07/24/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X357013CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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