MEDICARE: DENISE CHRISTINE FAMBO-DEMARTEAU PHD, MS, RAAP,VAIDYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171400000X	Health & Wellness Coach
2	106H00000X	Marriage & Family Therapist
3	174400000X	Specialist
4	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1053298422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE CHRISTINE FAMBO-DEMARTEAU PHD, MS, RAAP,VAIDYA

Provider Business Mailing Address
First Line	:	26877 SNOWMASS LOOP
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-2408
Country	:	US
Telephone Number	:	310-439-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	26877 SNOWMASS LOOP
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-2408
Country	:	US
Telephone Number	:	310-593-3304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	04/07/2026

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