Provider Demographics
NPI:1790769156
Name:GUALTIERI, CHRISTOPHER JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:GUALTIERI
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 1:3969 FOURTH AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3165
Mailing Address - Country:US
Mailing Address - Phone:619-688-2648
Mailing Address - Fax:619-688-2626
Practice Address - Street 1:3969 4TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3165
Practice Address - Country:US
Practice Address - Phone:619-688-2648
Practice Address - Fax:619-688-2626
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7398036Medicaid
CA00G730200Medicaid
CAG73020OtherCALIF STATE LICENSE
CAG73020OtherCALIF STATE LICENSE
CABG4619916OtherDEA
CAG73020OtherCALIF STATE LICENSE