Healthcare Provider Details

I. General information

NPI: 1992130165
Provider Name (Legal Business Name): CHRISTOPHER DAVON SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N OAK ST APT D
ORANGE CA
92867-7727
US

IV. Provider business mailing address

240 N OAK ST APT D
ORANGE CA
92867-7727
US

V. Phone/Fax

Practice location:
  • Phone: 714-858-1491
  • Fax:
Mailing address:
  • Phone: 714-858-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: