Healthcare Provider Details

I. General information

NPI: 1235855941
Provider Name (Legal Business Name): CRISTINA CARVAJAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 W 190TH ST STE 1149W190
GARDENA CA
90248-4321
US

IV. Provider business mailing address

1149 W 190TH ST STE 2200
GARDENA CA
90248-4344
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-0800
  • Fax: 855-568-2494
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number373H00000X
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: