=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932500295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA CACIANTI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2014
-----------------------------------------------------
Last Update Date | 09/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14901 CENTRAL AVE
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91710-9500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-217-5986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1214 ENGLAND ST
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-500-3538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY15043
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------