Provider Demographics
NPI:1487619359
Name:NOLAN, CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24407 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3650
Mailing Address - Country:US
Mailing Address - Phone:949-364-2813
Mailing Address - Fax:949-364-2873
Practice Address - Street 1:24407 CALLE DE LA LOUISA
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3650
Practice Address - Country:US
Practice Address - Phone:949-364-2813
Practice Address - Fax:949-364-2873
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39027208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390271Medicaid
CAB56451Medicare UPIN
CA00G390271Medicaid