Healthcare Provider Details

I. General information

NPI: 1124538202
Provider Name (Legal Business Name): CHARISSE REGINA PALAAD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W VENTURA BLVD STE 230
CAMARILLO CA
93010-9142
US

IV. Provider business mailing address

400 W VENTURA BLVD STE 230
CAMARILLO CA
93010-9142
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 858-264-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-40802
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: