Provider Demographics
NPI:1871320630
Name:LUBRIN, CHRISTIAN CHAN (RN)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:CHAN
Last Name:LUBRIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 MUNDY LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-7259
Mailing Address - Country:US
Mailing Address - Phone:209-200-8555
Mailing Address - Fax:
Practice Address - Street 1:12504 MUNDY LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-7259
Practice Address - Country:US
Practice Address - Phone:209-200-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95314441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse