Provider Demographics
NPI:1922468784
Name:CIAMAICHELO, CHRISTOPHER JULES (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JULES
Last Name:CIAMAICHELO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S HELBERTA AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3489
Mailing Address - Country:US
Mailing Address - Phone:310-897-8429
Mailing Address - Fax:
Practice Address - Street 1:801 S CHEVY CHASE DR STE 106
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4437
Practice Address - Country:US
Practice Address - Phone:310-897-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9361105367500000X
CA95000771367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered