Provider Demographics
NPI:1396032553
Name:CHRISTIAN BENTLEY, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTIAN BENTLEY, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:MPOWR ORTHOPAEDIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-295-2995
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:SUITE 265
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-295-2995
Mailing Address - Fax:760-295-2906
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:SUITE 265
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-295-2995
Practice Address - Fax:760-295-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68137207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68137OtherCALIFORNIA MEDICAL LICENSE