Provider Demographics
NPI:1538946108
Name:CO, CHRISTINA (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3223
Mailing Address - Country:US
Mailing Address - Phone:626-592-5040
Mailing Address - Fax:
Practice Address - Street 1:1217 S RAMONA ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3223
Practice Address - Country:US
Practice Address - Phone:626-592-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program