MEDICARE: CHRISTA VONZYCHLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1033688965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA VONZYCHLIN

Provider Business Mailing Address
First Line	:	4337 DEL PRADO WAY
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1816
Country	:	US
Telephone Number	:	920-489-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	4337 DEL PRADO WAY
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1816
Country	:	US
Telephone Number	:	920-489-0650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	11/20/2018

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Directions to “ CHRISTA VONZYCHLIN ” Practice Location

Language	Start Address	Practice Location

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