Healthcare Provider Details

I. General information

NPI: 1831760933
Provider Name (Legal Business Name): CHRISTOPHER MAGTANGOG YAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5332 JACKSON DR
LA MESA CA
91942-3040
US

IV. Provider business mailing address

9431 GOLD COAST DR UNIT F7
SAN DIEGO CA
92126-3957
US

V. Phone/Fax

Practice location:
  • Phone: 888-255-9280
  • Fax:
Mailing address:
  • Phone: 619-245-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95247379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: