Provider Demographics
NPI:1497350664
Name:CHRISTOPHER, DARYL
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 E HARWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6655
Mailing Address - Country:US
Mailing Address - Phone:702-266-6443
Mailing Address - Fax:
Practice Address - Street 1:6373 COPPERFIELD AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-1728
Practice Address - Country:US
Practice Address - Phone:702-266-6443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)