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General NPI Number Information
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NPI Number | 1053298422
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Entity Type | Individual
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Provider Name | AJAH-CHRISTINE DENISE FAMBO-DEMARTEAU PHD, AAP, VAIDYA
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Gender | Female
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 26877 SNOWMASS LOOP
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City | VALENCIA
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State | CA
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Zip | 91381-2408
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Country | US
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Telephone | 310-593-3304
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Fax |
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Provider Business Mailing Address
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Address Line | 13900 MARQUESAS WAY APT 3109
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6024
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Country | US
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Telephone | 431-059-3304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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Taxonomy #6
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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