Provider Demographics
NPI:1114682028
Name:GARCIA, CHANTELL NARAYA (ASSOCIATE IN ARTS)
Entity Type:Individual
Prefix:MS
First Name:CHANTELL
Middle Name:NARAYA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:ASSOCIATE IN ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 N VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3307
Mailing Address - Country:US
Mailing Address - Phone:818-571-3277
Mailing Address - Fax:
Practice Address - Street 1:1918 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3439
Practice Address - Country:US
Practice Address - Phone:909-918-7223
Practice Address - Fax:909-610-1345
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician