Provider Demographics
NPI:1568020576
Name:CHAICHAN NARTEA, PATHIDA EMMA
Entity Type:Individual
Prefix:
First Name:PATHIDA
Middle Name:EMMA
Last Name:CHAICHAN NARTEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23046 AVENIDA DE LA CARLOTA STE 600
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1537
Mailing Address - Country:US
Mailing Address - Phone:949-543-6950
Mailing Address - Fax:888-403-6922
Practice Address - Street 1:23046 AVENIDA DE LA CARLOTA STE 600
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1537
Practice Address - Country:US
Practice Address - Phone:949-543-6950
Practice Address - Fax:888-403-6922
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-07-3755103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst