Provider Demographics
NPI:1639674419
Name:RAFANAN, CAYTLAN MARIE GARDNER
Entity Type:Individual
Prefix:
First Name:CAYTLAN MARIE
Middle Name:GARDNER
Last Name:RAFANAN
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 1:3275 E HEDGES AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4065
Mailing Address - Country:US
Mailing Address - Phone:717-855-3047
Mailing Address - Fax:
Practice Address - Street 1:7339 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2954
Practice Address - Country:US
Practice Address - Phone:559-229-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician