Healthcare Provider Details

I. General information

NPI: 1083801583
Provider Name (Legal Business Name): MR. CHRIS LEVENTIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 OCEAN RANCH BLVD
OCEANSIDE CA
92056-2669
US

IV. Provider business mailing address

3606 OCEAN RANCH BLVD
OCEANSIDE CA
92056-2669
US

V. Phone/Fax

Practice location:
  • Phone: 760-231-8189
  • Fax:
Mailing address:
  • Phone: 760-231-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: