Provider Demographics
NPI:1497633135
Name:BOSCARDIN, CHRISTIAN JAMES (DAOM)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JAMES
Last Name:BOSCARDIN
Suffix:
Gender:M
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 WOLF ST # 2979
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-4503
Mailing Address - Country:US
Mailing Address - Phone:530-546-8201
Mailing Address - Fax:
Practice Address - Street 1:695 WOLF ST # 2979
Practice Address - Street 2:
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143-4503
Practice Address - Country:US
Practice Address - Phone:530-546-8201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20087171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist