Healthcare Provider Details

I. General information

NPI: 1689168551
Provider Name (Legal Business Name): CHRISTINE MIFFITT RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15355 IRON CANYON RD
SANTA CLARITA CA
91387-4745
US

IV. Provider business mailing address

19536 CASTILLE LN
SANTA CLARITA CA
91350-3875
US

V. Phone/Fax

Practice location:
  • Phone: 760-282-8081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-37635
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: