Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 100256 | CA |
NPI | 1063942902 |
---|---|
Provider Name | Ryann Christensen |
First Address | Fresno, CA 93711-0136 |
Second Address | Fresno, CA 93722-9325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 17/03/2018 |