Provider Demographics
NPI:1780995092
Name:NITOLLAMA, CHRISTOPHER PAUL (MSPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:NITOLLAMA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12570 GREEN WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2908
Mailing Address - Country:US
Mailing Address - Phone:714-230-0062
Mailing Address - Fax:
Practice Address - Street 1:5000 AIRPORT PLAZA DR
Practice Address - Street 2:240
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1271
Practice Address - Country:US
Practice Address - Phone:562-421-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist