Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 3675 | AZ |
N | 207VG0400X | Gynecologist | 3675 | AZ |
NPI | 1033252325 |
---|---|
Provider Name | Christina Goldstein-Charbonneau |
First Address | Bullhead City, AZ 86442-8492 |
Second Address | Bullhead City, AZ 86442-8492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 14/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
617847 | (05) | AZ |