Provider Demographics
NPI:1952660284
Name:CHRISTO MEDICAL DISTRIBUTOR
Entity Type:Organization
Organization Name:CHRISTO MEDICAL DISTRIBUTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NGOCHO
Authorized Official - Last Name:TEFORLACK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:213-300-2435
Mailing Address - Street 1:407 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-5803
Mailing Address - Country:US
Mailing Address - Phone:213-300-2435
Mailing Address - Fax:
Practice Address - Street 1:407 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5803
Practice Address - Country:US
Practice Address - Phone:213-300-2435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies