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General NPI Number Information
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NPI Number | 1720500499
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Entity Type | Individual
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Provider Name | CHRISTOPHER MARK RECUPERO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2017
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Last Update Date | 07/13/2017
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Provider Practice Location Address
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Address Line | 714 W OLYMPIC BLVD STE 704
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City | LOS ANGELES
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State | CA
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Zip | 90015-1439
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Country | US
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Telephone | 310-712-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 455 S LA PEER DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3503
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Country | US
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Telephone | 310-888-0025
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 16737
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License Number State | CA
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