Provider Demographics
NPI:1487025649
Name:DOSTALEK, CHRISTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:
Last Name:DOSTALEK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 TUXEDO TER
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2462
Mailing Address - Country:US
Mailing Address - Phone:818-631-0937
Mailing Address - Fax:
Practice Address - Street 1:5916 TUXEDO TER
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-2462
Practice Address - Country:US
Practice Address - Phone:818-631-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program