Healthcare Provider Details

I. General information

NPI: 1356163067
Provider Name (Legal Business Name): CHRISTELLE LARISSA JOHOU TCHAFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WILSHIRE BLVD STE 900
LOS ANGELES CA
90017-2613
US

IV. Provider business mailing address

1133 W BLAINE ST APT 19
RIVERSIDE CA
92507-3654
US

V. Phone/Fax

Practice location:
  • Phone: 213-542-2266
  • Fax:
Mailing address:
  • Phone: 951-742-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: