Provider Demographics
NPI:1508253634
Name:KERRIGAN, CHRISTOPHER P
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:KERRIGAN
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 1:5855 OLIVAS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7672
Mailing Address - Country:US
Mailing Address - Phone:805-652-5469
Mailing Address - Fax:
Practice Address - Street 1:1280 S VICTORIA AVENUE STE 250
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6521
Practice Address - Country:US
Practice Address - Phone:805-351-0745
Practice Address - Fax:805-288-6744
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA165043207RA0401X
MTMED-RES-LIC-42280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine