Provider Demographics
NPI:1215642947
Name:LAFFERTY, CHRISTINE MADUBUEZE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MADUBUEZE
Last Name:LAFFERTY
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 1:9201 W SUNSET BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3705
Mailing Address - Country:US
Mailing Address - Phone:424-284-3000
Mailing Address - Fax:424-249-3515
Practice Address - Street 1:9201 W SUNSET BLVD STE 415
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3705
Practice Address - Country:US
Practice Address - Phone:424-284-3000
Practice Address - Fax:424-249-3515
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95089483163W00000X
CA95013518363LP0222X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care