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General NPI Number Information
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NPI Number | 1922639590
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Entity Type | Organization
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Legal Business Name | CHRISTIAN NATIONAL CHURCH
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 1350 E CHAPMAN AVE
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City | FULLERTON
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State | CA
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Zip | 92834-7400
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Country | US
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Telephone | 425-387-7233
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Fax |
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Provider Business Mailing Address
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Address Line | GENERAL DELIVERY
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City | FULLERTON
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State | CA
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Zip | 92834-9999
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Country | US
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Telephone | 425-387-7233
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Fax |
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Authorized Official
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Title or Position | OFFICER/PROVIDER
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Name | MR. BRYANT LAMONT BALL
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Credential | MD
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Telephone | 425-387-7233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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