Healthcare Provider Details

I. General information

NPI: 1548716772
Provider Name (Legal Business Name): CHRISTOPHER TOPHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 BROADWAY ST SUITE 218
REDWOOD CITY CA
94063-3187
US

IV. Provider business mailing address

36 MONTEREY BOULEVARD SUITE A
SAN FRANCISCO CA
94131
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax: 877-539-7730
Mailing address:
  • Phone: 877-264-6747
  • Fax: 877-539-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-23267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: