Healthcare Provider Details

I. General information

NPI: 1538090980
Provider Name (Legal Business Name): CHRISTOPHER WOLDRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6702 WANDERMERE DR
SAN DIEGO CA
92120-3250
US

IV. Provider business mailing address

1406 WHITSETT DR
EL CAJON CA
92020-1752
US

V. Phone/Fax

Practice location:
  • Phone: 858-988-2700
  • Fax:
Mailing address:
  • Phone: 619-851-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: