Healthcare Provider Details

I. General information

NPI: 1720698806
Provider Name (Legal Business Name): CHRISTINA KAMATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26720 YNEZ CT
TEMECULA CA
92591-4659
US

IV. Provider business mailing address

26720 YNEZ CT
TEMECULA CA
92591-4659
US

V. Phone/Fax

Practice location:
  • Phone: 951-813-4034
  • Fax: 951-813-4035
Mailing address:
  • Phone: 951-813-4034
  • Fax: 951-813-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58375
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-71052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: