Healthcare Provider Details

I. General information

NPI: 1295853745
Provider Name (Legal Business Name): CHRISTOPHER M RIDGEWAY HS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 E EL SEGUNDO BLVD
COMPTON CA
90222-7109
US

IV. Provider business mailing address

1838 W 35TH ST
LOS ANGELES CA
90018-3807
US

V. Phone/Fax

Practice location:
  • Phone: 310-637-0917
  • Fax: 310-637-0473
Mailing address:
  • Phone: 323-732-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: