Provider Demographics
NPI:1851838627
Name:CHURGIN, CABRINA
Entity Type:Individual
Prefix:
First Name:CABRINA
Middle Name:
Last Name:CHURGIN
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 1:800 FERRARI
Mailing Address - Street 2:#100
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5030
Mailing Address - Country:US
Mailing Address - Phone:909-484-2848
Mailing Address - Fax:
Practice Address - Street 1:800 FERRARI
Practice Address - Street 2:#100
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5030
Practice Address - Country:US
Practice Address - Phone:909-484-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-29168106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician