Provider Demographics
NPI:1205363066
Name:VIOLETTI, MARK CHRISTOPHER (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:VIOLETTI
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PARK CENTER DR
Mailing Address - Street 2:STE 1400
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7155
Mailing Address - Country:US
Mailing Address - Phone:530-262-5579
Mailing Address - Fax:
Practice Address - Street 1:3700 S PLAZA DR APT F108
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7401
Practice Address - Country:US
Practice Address - Phone:530-262-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-32481103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst