Provider Demographics
NPI:1003373986
Name:MISLANG, CHARMAINE C
Entity Type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:C
Last Name:MISLANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARMAINE MARIZ
Other - Middle Name:C
Other - Last Name:MISLANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12626 RIVERSIDE DR STE 409
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3451
Mailing Address - Country:US
Mailing Address - Phone:818-661-6306
Mailing Address - Fax:
Practice Address - Street 1:12626 RIVERSIDE DR STE 409
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3451
Practice Address - Country:US
Practice Address - Phone:818-661-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician