Healthcare Provider Details

I. General information

NPI: 1831577626
Provider Name (Legal Business Name): CHRISTOFFEL JOHANNES VAN NIEKERK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTOFF VAN NIEKERK M.D.

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9898 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-5115
  • Fax:
Mailing address:
  • Phone: 858-824-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA145679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME161797
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA145679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: