Healthcare Provider Details

I. General information

NPI: 1508432030
Provider Name (Legal Business Name): CHRISTOPHER GEORGE GARDHOUSE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 INDIAN HILLS RD STE 261
MISSION HILLS CA
91345-1244
US

IV. Provider business mailing address

11550 INDIAN HILLS RD STE 261
MISSION HILLS CA
91345-1244
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-0917
  • Fax: 818-361-1606
Mailing address:
  • Phone: 818-361-0917
  • Fax: 818-361-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number59889
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number59889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: