Provider Demographics
NPI:1982286498
Name:DATILES, CHRISTOPHER MAGPANTAY
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MAGPANTAY
Last Name:DATILES
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 1:5619 N FIGUEROA ST APT 223
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4979
Mailing Address - Country:US
Mailing Address - Phone:213-302-5216
Mailing Address - Fax:
Practice Address - Street 1:1920 HILLHURST AVE # 437
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2712
Practice Address - Country:US
Practice Address - Phone:213-279-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4244101YM0800X
CA13266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health