Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A73675 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A73675 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A73675 | CA |
NPI | 1437375094 |
---|---|
Provider Name | Christianne Bishop |
First Address | Modesto, CA 95355 |
Second Address | Modesto, CA 95355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8313223 | (05) | WA |
H58310 | (02) | WA |