Provider Demographics
NPI:1942014667
Name:CORCORAN, CHRISTINE CHEN (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CHEN
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 EAGLE ROCK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2087
Mailing Address - Country:US
Mailing Address - Phone:747-300-7541
Mailing Address - Fax:818-471-4287
Practice Address - Street 1:5015 EAGLE ROCK BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2087
Practice Address - Country:US
Practice Address - Phone:747-300-7541
Practice Address - Fax:818-471-4287
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily