1871296301 NPI number — MR. CHRISTOPHER RYAN BOECKMANN MONTGOMERY MPH, MD

Table of content: MRS. MURYEL WARD VARY PA-C (NPI 1881086742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871296301 NPI number — MR. CHRISTOPHER RYAN BOECKMANN MONTGOMERY MPH, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
CHRISTOPHER
Provider Middle Name:
RYAN BOECKMANN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPH, MD
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:
1871296301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 GLENDON AVE STE 1200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90024-3516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-794-0785
Provider Business Mailing Address Fax Number:
310-794-0599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 WESTWOOD PLZ
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-7419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-0785
Provider Business Practice Location Address Fax Number:
310-794-0599
Provider Enumeration Date:
03/23/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com