Provider Demographics
NPI:1558409714
Name:FRAGISKATOS, CHRIS ANGELO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ANGELO
Last Name:FRAGISKATOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 336
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3902
Mailing Address - Country:US
Mailing Address - Phone:619-990-4787
Mailing Address - Fax:619-391-8736
Practice Address - Street 1:3435 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 336
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3902
Practice Address - Country:US
Practice Address - Phone:619-990-4787
Practice Address - Fax:619-391-8736
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist