Provider Demographics
NPI:1619012440
Name:AGU, CHRISTOPHER KANAYO (PPS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KANAYO
Last Name:AGU
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 W VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5804
Mailing Address - Country:US
Mailing Address - Phone:310-868-5379
Mailing Address - Fax:
Practice Address - Street 1:1055 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90220-5804
Practice Address - Country:US
Practice Address - Phone:310-868-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XOtherCOUNSELOR-MENTAL HEALTH