Provider Demographics
NPI:1992823959
Name:CHRISTOPHER JOSEPH GUALTIERI MD APC
Entity Type:Organization
Organization Name:CHRISTOPHER JOSEPH GUALTIERI MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GUALTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-688-2648
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 FOURTH AVENUE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7398036Medicaid
CAW18414Medicare PIN