Healthcare Provider Details

I. General information

NPI: 1710334479
Provider Name (Legal Business Name): MR. CHRISTOPHER MOLITORIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 W OLYMPIC BLVD FL 1
LOS ANGELES CA
90064-1937
US

IV. Provider business mailing address

11080 W OLYMPIC BLVD FL 1
LOS ANGELES CA
90064-1937
US

V. Phone/Fax

Practice location:
  • Phone: 310-966-6610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: