Provider Demographics
NPI:1942512454
Name:TEICH, CHRISTOPHER STANLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STANLEY
Last Name:TEICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 MATEO DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-5451
Mailing Address - Country:US
Mailing Address - Phone:707-992-0672
Mailing Address - Fax:
Practice Address - Street 1:181 ANDRIEUX ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6932
Practice Address - Country:US
Practice Address - Phone:707-996-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant