MEDICARE: MR. BRENT DAVID CHUMPITAZI M.S.

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	106H00000X	Marriage & Family Therapist	104587	CA

General Provider Information

NPI Number	:	1568868461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT DAVID CHUMPITAZI M.S.

Provider Business Mailing Address
First Line	:	17692 BEACH BLVD STE 300
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6851
Country	:	US
Telephone Number	:	714-487-8320
Fax Number	:	714-254-8480

Provider Business Practice Location Address
First Line	:	17692 BEACH BLVD STE 300
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6851
Country	:	US
Telephone Number	:	714-487-8320
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	02/07/2025

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