Provider Demographics
NPI:1508377268
Name:WONG, CHRISTOPHER PHILIPS (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PHILIPS
Last Name:WONG
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 SPRINGMILL PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6324
Mailing Address - Country:US
Mailing Address - Phone:626-376-2189
Mailing Address - Fax:
Practice Address - Street 1:2930 INLAND EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4802
Practice Address - Country:US
Practice Address - Phone:909-483-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-26669103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst