MEDICARE: DR. CHRISTOPHER ANTHONY WYBOURN MD

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	208600000X	Surgery Physician	A130416	CA

General Provider Information

NPI Number	:	1629206925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER ANTHONY WYBOURN MD

Provider Business Mailing Address
First Line	:	7930 FROST ST
Second Line	:	STE 204
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2739
Country	:	US
Telephone Number	:	858-565-0104
Fax Number	:	858-565-0194

Provider Business Practice Location Address
First Line	:	7930 FROST ST
Second Line	:	STE 204
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2739
Country	:	US
Telephone Number	:	858-565-0104
Fax Number	:	858-565-0194

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	11/25/2020

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