Healthcare Provider Details

I. General information

NPI: 1477189330
Provider Name (Legal Business Name): CHRISTOPHER JOHN PELLEGRINO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23961 CALLE DE LA MAGDALENA STE 500
LAGUNA HILLS CA
92653-7622
US

IV. Provider business mailing address

23961 CALLE DE LA MAGDALENA STE 500
LAGUNA HILLS CA
92653-7622
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-1101
  • Fax: 949-289-9171
Mailing address:
  • Phone: 949-855-1101
  • Fax: 949-289-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA185811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: