Provider Demographics
NPI:1285623546
Name:BASER, CHRISTINE A (RN, PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:BASER
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 PALOMAR AIRPORT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1431
Mailing Address - Country:US
Mailing Address - Phone:760-431-2695
Mailing Address - Fax:760-431-2695
Practice Address - Street 1:2011 PALOMAR AIRPORT RD STE 205
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1431
Practice Address - Country:US
Practice Address - Phone:760-431-2695
Practice Address - Fax:760-431-2695
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9695103T00000X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9695Medicare ID - Type Unspecified