Basic Information
| Provider Information | |||||||||
| NPI: | 1639319577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABERNATHY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 510 S 2ND AVE | ||||||||
| Address2: | STE.6 | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263327122 | ||||||||
| FaxNumber: | 6269748198 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 S 2ND AVE | ||||||||
| Address2: | STE 6 | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263327122 | ||||||||
| FaxNumber: | 6269748198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 08/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.