Provider Demographics
NPI:1144497769
Name:EGAN, CHRISTINE (MPH PT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:MPH PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 HUCKLEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1270
Mailing Address - Country:US
Mailing Address - Phone:415-455-9721
Mailing Address - Fax:415-491-9735
Practice Address - Street 1:64 MAIN ST #2 REAR
Practice Address - Street 2:
Practice Address - City:PT SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964-0345
Practice Address - Country:US
Practice Address - Phone:415-455-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16514174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist