Healthcare Provider Details

I. General information

NPI: 1063645182
Provider Name (Legal Business Name): CHRISTYLCARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 MARTIN LUTHER KING JR BLVD SUITE 108
LYNWOOD CA
90262-2685
US

IV. Provider business mailing address

3611 MARTIN LUTHER KING JR BLVD SUITE 108
LYNWOOD CA
90262-2685
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-2588
  • Fax: 310-537-9456
Mailing address:
  • Phone: 310-537-2588
  • Fax: 310-537-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: COMFORT MCCLAIN
Title or Position: OFFICE MANAGER
Credential: MD
Phone: 310-537-2588