Basic Information
| Provider Information | |||||||||
| NPI: | 1932145620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E. CHURCH STREET | ||||||||
| Address2: | ATTENTION: MEDICAL STAFF OFFICE | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393954 | ||||||||
| FaxNumber: | 8057393060 | ||||||||
| Practice Location | |||||||||
| Address1: | 877 OAK PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | PISMO BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054748450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G81578 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 050359CG49067 | 01 | CA | TULARE TRAILBLAZER | OTHER | 00G815780 | 01 | CA | CALOPTIMA | OTHER | 00G815780 | 01 | CA | BLUE SHIELD | OTHER | P00250832 | 01 | CA | TULARE RAILROAD | OTHER | G81578 | 01 | CA | BLUE CROSS | OTHER | 00G815780 | 05 | CA | MEDICAID |