Healthcare Provider Details

I. General information

NPI: 1508253634
Provider Name (Legal Business Name): CHRISTOPHER P KERRIGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 S VICTORIA AVENUE STE 250
VENTURA CA
93003-6521
US

IV. Provider business mailing address

5855 OLIVAS PARK DR
VENTURA CA
93003-7672
US

V. Phone/Fax

Practice location:
  • Phone: 805-351-0745
  • Fax: 805-288-6744
Mailing address:
  • Phone: 805-652-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA165043
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMED-RES-LIC-42280
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: