Individual
CHRISTOPHER LARRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
47915 OASIS ST, INDIO, CA 92201-6950
(909) 437-5936
Mailing address
PO BOX 3973, RANCHO CUCAMONGA, CA 91729-3973
(909) 437-5936
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT29856
CA
Other
Enumeration date
06/08/2015
Last updated
06/08/2015
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