Healthcare Provider Details

I. General information

NPI: 1174087696
Provider Name (Legal Business Name): CHRISTOPHER JOHN ZURES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 215
SAN DIEGO CA
92130-2054
US

IV. Provider business mailing address

6113 CALERA PL
SAN DIEGO CA
92130-6923
US

V. Phone/Fax

Practice location:
  • Phone: 619-213-2079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC5986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12828430-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: