Provider Demographics
NPI:1154083467
Name:BOSS, CHRISTOPHER DRAKE (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DRAKE
Last Name:BOSS
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 PLEASANT AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2385
Mailing Address - Country:US
Mailing Address - Phone:714-312-8241
Mailing Address - Fax:
Practice Address - Street 1:1509 PLEASANT AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2385
Practice Address - Country:US
Practice Address - Phone:714-312-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86278099133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered