Healthcare Provider Details

I. General information

NPI: 1639725427
Provider Name (Legal Business Name): MARK CHRISTIAN COUNTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-7279
  • Fax:
Mailing address:
  • Phone: 760-256-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: