Basic Information
Provider Information
NPI: 1003805292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTINA
FirstName: MELANIE
MiddleName: OWEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8230 WALNUT HILL LN
Address2: STE 804
City: DALLAS
State: TX
PostalCode: 752314409
CountryCode: US
TelephoneNumber: 2143693279
FaxNumber: 2143690056
Practice Location
Address1: 8210 WALNUT HILL LN
Address2: #408
City: DALLAS
State: TX
PostalCode: 752314405
CountryCode: US
TelephoneNumber: 2143693279
FaxNumber: 2143690056
Other Information
ProviderEnumerationDate: 10/19/2005
LastUpdateDate: 06/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XJ3766TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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