Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 95008313 | CA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95008313 | CA |
NPI | 1568905990 |
---|---|
Provider Name | Christina Hanisch |
First Address | San Diego, CA 92122-5931 |
Second Address | San Diego, CA 92122-5931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2016 |
Last Update Date | 25/08/2021 |