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NPI Code Detail

MEDICARE: CHARISSE REGINA PALAAD MS

MEDICARE: CHARISSE REGINA PALAAD MS
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-17-40802CA
2103K00000XBehavior Analyst1-20-45153CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
145-3589857OTHERTHE HOLMAN GROUP

General Provider Information

NPI Number : 1124538202
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARISSE REGINA PALAAD MS
Provider Business Mailing Address
First Line : 400 W VENTURA BLVD STE 230
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-9142
Country : US
Telephone Number : 858-264-5858
Fax Number :
Provider Business Practice Location Address
First Line : 400 W VENTURA BLVD STE 230
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-9142
Country : US
Telephone Number : 858-264-5858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2017
Last Update Date : 10/08/2020

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Directions to “ CHARISSE REGINA PALAAD MS” Practice Location

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