Healthcare Provider Details

I. General information

NPI: 1841142254
Provider Name (Legal Business Name): CHRISTALYN LEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 CHARLEVILLE BLVD # 312
BEVERLY HILLS CA
90212-3017
US

IV. Provider business mailing address

4534 VISTA DEL MONTE AVE APT 106
SHERMAN OAKS CA
91403-2927
US

V. Phone/Fax

Practice location:
  • Phone: 747-217-7956
  • Fax:
Mailing address:
  • Phone: 747-217-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: