MEDICARE: DR. CHRISTOPHER STRUBLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A122727	CA

General Provider Information

NPI Number	:	1073812756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER STRUBLE M.D.

Provider Business Mailing Address
First Line	:	505 N LUCIA AVE # A
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3009
Country	:	US
Telephone Number	:	650-450-9520
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 N PACIFIC COAST HWY STE 273
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6853
Country	:	US
Telephone Number	:	650-450-9520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	07/29/2015

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