Basic Information
Provider Information
NPI: 1871931436
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TERRONES
FirstName: CHRISTINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ANP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4920 AVALON BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900114004
CountryCode: US
TelephoneNumber: 3232355035
FaxNumber: 3232352023
Practice Location
Address1: 4920 AVALON BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900114004
CountryCode: US
TelephoneNumber: 3232355035
FaxNumber: 3232352023
Other Information
ProviderEnumerationDate: 06/05/2013
LastUpdateDate: 09/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X370009CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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