Provider Demographics
NPI:1154963726
Name:COLUNGA, CHRISTIAN ALEXANDER
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ALEXANDER
Last Name:COLUNGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 W COLLEGE AVE APT 2034
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-7022
Mailing Address - Country:US
Mailing Address - Phone:909-436-9161
Mailing Address - Fax:
Practice Address - Street 1:572 N ARROWHEAD AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1217
Practice Address - Country:US
Practice Address - Phone:909-266-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst