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NPI Code Detail

MEDICARE: CHRISTOPHER GEORGE GARDHOUSE PA-C

MEDICARE: CHRISTOPHER GEORGE GARDHOUSE PA-C
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
1363AS0400XSurgical Physician Assistant59889CA
2363A00000XPhysician AssistantPA59889CA
3363AM0700XMedical Physician Assistant59889CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA59889OTHERCASTATE MEDICAL LICENSE

General Provider Information

NPI Number : 1508432030
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER GEORGE GARDHOUSE PA-C
Provider Business Mailing Address
First Line : PO BOX 1730
Second Line :
City : RANCHO MIRAGE
State : CA
Zip : 92270-1058
Country : US
Telephone Number : 760-766-1249
Fax Number : 760-837-2269
Provider Business Practice Location Address
First Line : 558 SAINT CHARLES DR STE 200
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-3968
Country : US
Telephone Number : 805-379-2322
Fax Number : 805-379-2322
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2021
Last Update Date : 09/26/2025

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