Provider Demographics
NPI:1285213132
Name:CHRISTIAN R SMALL MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTIAN R SMALL MD A PROFESSIONAL CORPORATION
Other - Org Name:HEADLANDS ADDICTION TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-704-9429
Mailing Address - Street 1:215 S HICKORY ST STE 114
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4360
Mailing Address - Country:US
Mailing Address - Phone:760-704-9429
Mailing Address - Fax:
Practice Address - Street 1:215 S HICKORY ST STE 114
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4360
Practice Address - Country:US
Practice Address - Phone:760-704-9429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty