Provider Demographics
NPI:1790086916
Name:GALE, CHRISTOPHER-MICHAEL (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER-MICHAEL
Middle Name:
Last Name:GALE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:1001
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3901
Mailing Address - Country:US
Mailing Address - Phone:213-977-1176
Mailing Address - Fax:213-977-0668
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:1001
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-977-1176
Practice Address - Fax:213-977-0668
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB207407Medicare PIN