Healthcare Provider Details

I. General information

NPI: 1053298422
Provider Name (Legal Business Name): DENISE CHRISTINE FAMBO-DEMARTEAU PHD, MS, RAAP,VAIDYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AJAH-CHRISTINE FAMBO PHD, MS, RAAP,VAIDYA

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26877 SNOWMASS LOOP
VALENCIA CA
91381-2408
US

IV. Provider business mailing address

26877 SNOWMASS LOOP
VALENCIA CA
91381-2408
US

V. Phone/Fax

Practice location:
  • Phone: 310-593-3304
  • Fax:
Mailing address:
  • Phone: 310-439-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: