1174789960 NPI number — CHRISTOPHER JON MCDONALD PSY D

Table of content: CHRISTOPHER JON MCDONALD PSY D (NPI 1174789960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174789960 NPI number — CHRISTOPHER JON MCDONALD PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDONALD
Provider First Name:
CHRISTOPHER
Provider Middle Name:
JON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174789960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 9TH STREET
Provider Second Line Business Mailing Address:
ROOM 205 MAILSTOP 2-3
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95814-6414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-654-2431
Provider Business Mailing Address Fax Number:
916-654-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10333 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93423-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-468-2000
Provider Business Practice Location Address Fax Number:
805-466-6011
Provider Enumeration Date:
08/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY 15033 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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