Healthcare Provider Details

I. General information

NPI: 1932500295
Provider Name (Legal Business Name): DEBRA CACIANTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 CENTRAL AVE
CHINO CA
91710-9500
US

IV. Provider business mailing address

1214 ENGLAND ST
HUNTINGTON BEACH CA
92648-4112
US

V. Phone/Fax

Practice location:
  • Phone: 909-217-5986
  • Fax:
Mailing address:
  • Phone: 949-500-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: