Healthcare Provider Details

I. General information

NPI: 1245827666
Provider Name (Legal Business Name): ANDY CAHUANTZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
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

951 WARWICK AVE APT J3
THOUSAND OAKS CA
91360-3632
US

V. Phone/Fax

Practice location:
  • Phone: 858-264-5858
  • Fax:
Mailing address:
  • Phone: 805-807-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: