Provider Demographics
NPI:1396792339
Name:ARISMENDI, CHRISTOPHER MARK (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:ARISMENDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4347 PORTAGE ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7371
Mailing Address - Country:US
Mailing Address - Phone:800-527-0336
Mailing Address - Fax:330-244-8521
Practice Address - Street 1:420 W ACACIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2441
Practice Address - Country:US
Practice Address - Phone:209-466-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73525208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73525OtherMEDICAL LICENSE
CA00G735250Medicaid
CAF76140Medicare UPIN
CA00G735250Medicare ID - Type Unspecified