Provider Demographics
NPI:1306115126
Name:WARREN, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WARREN
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 1:55 SHELBY DR
Mailing Address - Street 2:A3
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5300
Mailing Address - Country:US
Mailing Address - Phone:928-282-3535
Mailing Address - Fax:928-282-1107
Practice Address - Street 1:55 SHELBY DR
Practice Address - Street 2:A3
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5300
Practice Address - Country:US
Practice Address - Phone:928-282-3535
Practice Address - Fax:928-282-1107
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20757067332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies