Healthcare Provider Details

I. General information

NPI: 1982510566
Provider Name (Legal Business Name): CHRISTOPHER DANIEL CARROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 W STETSON AVE STE 100
HEMET CA
92545-9682
US

IV. Provider business mailing address

26319 LAKE ST
HEMET CA
92544-6691
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-1600
  • Fax:
Mailing address:
  • Phone: 951-282-9825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: