Provider Demographics
NPI:1750550521
Name:TUTTLE, CHRISTOPHER MATTHEW
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 E AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2176
Mailing Address - Country:US
Mailing Address - Phone:619-996-4475
Mailing Address - Fax:
Practice Address - Street 1:756 E AVE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2176
Practice Address - Country:US
Practice Address - Phone:619-996-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)