Healthcare Provider Details

I. General information

NPI: 1063098556
Provider Name (Legal Business Name): CHRISTOPHER PAUL LONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30131 TOWN CENTER DR STE 247
LAGUNA NIGUEL CA
92677-2033
US

IV. Provider business mailing address

30131 TOWN CENTER DR STE 247
LAGUNA NIGUEL CA
92677-2033
US

V. Phone/Fax

Practice location:
  • Phone: 949-239-1103
  • Fax: 949-816-1549
Mailing address:
  • Phone: 949-239-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA196422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: