1639234826 NPI number — DR. CHRISTOPHER LOUIS SHERMAN DO

Table of content: DR. CHRISTOPHER LOUIS SHERMAN DO (NPI 1639234826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639234826 NPI number — DR. CHRISTOPHER LOUIS SHERMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERMAN
Provider First Name:
CHRISTOPHER
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1639234826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4445 EASTGATE MALL
Provider Second Line Business Mailing Address:
STE 105
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92121-1979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-267-3020
Provider Business Mailing Address Fax Number:
619-267-4042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4910 DIRECTORS PL STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-3834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-346-7171
Provider Business Practice Location Address Fax Number:
858-453-7314
Provider Enumeration Date:
12/27/2006

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: 207X00000X , with the licence number:  20A9789 , 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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