Provider Demographics
NPI:1861520934
Name:ROBERTS, CHRISTOPHER ALAN (LAC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17212 BERLIN LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4506
Mailing Address - Country:US
Mailing Address - Phone:562-755-6341
Mailing Address - Fax:
Practice Address - Street 1:1040 ELM AVE
Practice Address - Street 2:100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3264
Practice Address - Country:US
Practice Address - Phone:562-901-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist