Healthcare Provider Details

I. General information

NPI: 1225832157
Provider Name (Legal Business Name): CHRISTINA BLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

IV. Provider business mailing address

838 19TH ST APT 2
SANTA MONICA CA
90403-6711
US

V. Phone/Fax

Practice location:
  • Phone: 866-452-5273
  • Fax:
Mailing address:
  • Phone: 402-490-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1437290326
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: