Provider Demographics
NPI:1043081268
Name:CARRASQUILLO, CHRISTIAN PAUL
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:PAUL
Last Name:CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:CARRASQUILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1042 N MOUNTAIN AVE STE B560
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3695
Mailing Address - Country:US
Mailing Address - Phone:909-529-8965
Mailing Address - Fax:
Practice Address - Street 1:1730 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4417
Practice Address - Country:US
Practice Address - Phone:909-570-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical