Provider Demographics
NPI:1356637813
Name:DAVIS, CHRISTOPHER MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25500 RANCHO NIGUEL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7302
Mailing Address - Country:US
Mailing Address - Phone:949-643-0500
Mailing Address - Fax:949-643-3748
Practice Address - Street 1:25500 RANCHO NIGUEL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7302
Practice Address - Country:US
Practice Address - Phone:949-643-0500
Practice Address - Fax:949-643-3748
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A12389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB215981Medicare UPIN