Provider Demographics
NPI:1679083513
Name:CHRISTABELLE CO MD INC
Entity type:Organization
Organization Name:CHRISTABELLE CO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-808-9858
Mailing Address - Street 1:161 S SPRUCE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4517
Mailing Address - Country:US
Mailing Address - Phone:650-808-9848
Mailing Address - Fax:650-808-9848
Practice Address - Street 1:161 S SPRUCE AVE STE 205
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4517
Practice Address - Country:US
Practice Address - Phone:650-808-9848
Practice Address - Fax:650-808-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148358208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4066595OtherCORPORATION
CAA148358OtherCALIFORNIA MEDICAL LICENSE