Basic Information
| Provider Information | |||||||||
| NPI: | 1922154806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROTHERS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2663 SOVEREIGN WAY | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925065121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518099885 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11201 BENTON ST | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923571000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN 225437 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse | 164X00000X | 203982 | TX | N | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.