Provider Demographics
NPI:1053907154
Name:PABALATE, CHRISTINE JOY BACHO
Entity type:Individual
Prefix:
First Name:CHRISTINE JOY
Middle Name:BACHO
Last Name:PABALATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2968
Mailing Address - Country:US
Mailing Address - Phone:818-406-8196
Mailing Address - Fax:
Practice Address - Street 1:2460 22ND ST # W94
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2815
Practice Address - Country:US
Practice Address - Phone:628-206-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95090819163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY3533560Medicaid