Healthcare Provider Details

I. General information

NPI: 1528603446
Provider Name (Legal Business Name): MR. BRIAN B CHRISTISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 MISSION GORGE RD
SAN DIEGO CA
92120-3505
US

IV. Provider business mailing address

PO BOX 420814
SAN DIEGO CA
92142-0814
US

V. Phone/Fax

Practice location:
  • Phone: 619-285-6511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP23735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: