Provider Demographics
NPI:1336862390
Name:CHRISTOPHER, EBONY DESHAWN
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:DESHAWN
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23824 HAWTHORNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5935
Mailing Address - Country:US
Mailing Address - Phone:310-791-3064
Mailing Address - Fax:
Practice Address - Street 1:23824 HAWTHORNE BLVD STE 20023824
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5935
Practice Address - Country:US
Practice Address - Phone:310-791-3064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator