Provider Demographics
NPI:1619027752
Name:LINEBACK, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:LINEBACK
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 1:39765 DATE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2005
Mailing Address - Country:US
Mailing Address - Phone:951-894-4665
Mailing Address - Fax:
Practice Address - Street 1:39765 DATE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2005
Practice Address - Country:US
Practice Address - Phone:951-894-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine