Provider Demographics
NPI:1639108996
Name:VERBIN, CHRISTOPHER S (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:VERBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LOMITA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3900
Mailing Address - Country:US
Mailing Address - Phone:310-539-6500
Mailing Address - Fax:310-539-0147
Practice Address - Street 1:3600 LOMITA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3900
Practice Address - Country:US
Practice Address - Phone:310-539-6500
Practice Address - Fax:310-539-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954748784OtherTAX ID #
CAG76352OtherSTATE LICENSE
CAG76352OtherSTATE LICENSE