Provider Demographics
NPI:1871646695
Name:CHRISTIANSEN, MARTIN ROBB
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ROBB
Last Name:CHRISTIANSEN
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 1:1400 N NORMA ST
Mailing Address - Street 2:STE. 133
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2575
Mailing Address - Country:US
Mailing Address - Phone:760-499-7406
Mailing Address - Fax:760-499-7479
Practice Address - Street 1:1400 N NORMA ST
Practice Address - Street 2:STE 133
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2575
Practice Address - Country:US
Practice Address - Phone:760-499-7406
Practice Address - Fax:760-499-7479
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker