Basic Information
| Provider Information | |||||||||
| NPI: | 1881234847 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTOPHER | ||||||||
| FirstName: | TERRAL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26560 PEACHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925636354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515877260 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 27720 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925902610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516998640 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2020 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | E2310606 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.