Healthcare Provider Details

I. General information

NPI: 1255121828
Provider Name (Legal Business Name): BRITTANIA CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W SLAUSON AVE STE 168
CULVER CITY CA
90230-6584
US

IV. Provider business mailing address

1026 W 22ND ST APT 10
LOS ANGELES CA
90007-1818
US

V. Phone/Fax

Practice location:
  • Phone: 310-410-4450
  • Fax: 310-410-4455
Mailing address:
  • Phone: 323-798-6018
  • 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: