1275877698 NPI number — MS. CHANTI FRITZSCHING WATERS BCBA

Table of content: MS. CHANTI FRITZSCHING WATERS BCBA (NPI 1275877698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275877698 NPI number — MS. CHANTI FRITZSCHING WATERS BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATERS
Provider First Name:
CHANTI
Provider Middle Name:
FRITZSCHING
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRITZSCHING
Provider Other First Name:
CHANTI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275877698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
591 ASH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS OSOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-610-8064
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 SOUTH H STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMPOC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-610-8064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-02-0808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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