Healthcare Provider Details

I. General information

NPI: 1447813134
Provider Name (Legal Business Name): MICHAEL CHRISTIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N BARRANCA AVE # 6053
COVINA CA
91723-1722
US

IV. Provider business mailing address

440 N BARRANCA AVE # 6053
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA176221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: