Healthcare Provider Details

I. General information

NPI: 1215391511
Provider Name (Legal Business Name): CHRISTOFER AARON LOPEZ REYES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

IV. Provider business mailing address

3210 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-6500
  • Fax:
Mailing address:
  • Phone: 562-548-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: