Healthcare Provider Details

I. General information

NPI: 1619122454
Provider Name (Legal Business Name): MR. HARRY CHRISSAKIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13376 RUE MONTAIGNE
OREGON HOUSE CA
95962
US

IV. Provider business mailing address

PO BOX 832
OREGON HOUSE CA
95962-0832
US

V. Phone/Fax

Practice location:
  • Phone: 530-692-0420
  • Fax: 530-692-2656
Mailing address:
  • Phone: 530-692-0420
  • Fax: 530-692-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: