Healthcare Provider Details

I. General information

NPI: 1841725694
Provider Name (Legal Business Name): CHRISTOPHER INCLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NEOTOMAS AVE
SANTA ROSA CA
95405-7537
US

IV. Provider business mailing address

1450 NEOTOMAS AVE
SANTA ROSA CA
95405-7537
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-4700
  • Fax:
Mailing address:
  • Phone: 707-565-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: