Healthcare Provider Details

I. General information

NPI: 1053618652
Provider Name (Legal Business Name): CHRIS PARTIDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 13TH AVE
LUCERNE CA
95458
US

IV. Provider business mailing address

6302 13TH AVE
LUCERNE CA
95458
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-9101
  • Fax: 707-274-9192
Mailing address:
  • Phone: 707-994-7090
  • Fax: 707-994-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: