Healthcare Provider Details

I. General information

NPI: 1306365622
Provider Name (Legal Business Name): CHRISTOPHER STEPHEN HOLLINGHURST III N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 COMPTON AVE STE 102
CORONA CA
92881-7295
US

IV. Provider business mailing address

3660 PARK SIERRA DR STE 203
RIVERSIDE CA
92505-3071
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-0313
  • Fax:
Mailing address:
  • Phone: 951-687-3400
  • Fax: 951-687-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07170079
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: