Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A115187 | CA |
N | 207YS0123X | Facial Plastic Surgeon | A115187 | CA |
NPI | 1063741056 |
---|---|
Provider Name | Dr. Christian Patrick Conderman |
First Address | Orinda, CA 94563-3019 |
Second Address | Orinda, CA 94563-3019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2009 |
Last Update Date | 28/01/2022 |