Provider Demographics
NPI:1982703757
Name:FREDENBERG, CHRISTINA IRENE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:IRENE
Last Name:FREDENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 NO. 3RD ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-633-3800
Mailing Address - Fax:602-861-3500
Practice Address - Street 1:9250 NO. 3RD ST.
Practice Address - Street 2:SUITE 4000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-633-3800
Practice Address - Fax:602-861-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29993207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ740309Medicaid
AZZ73353Medicare PIN
AZH80797Medicare UPIN