Provider Demographics
NPI:1932502531
Name:KRISTOFIC, RACHEL COLLEEN (MAED, PPS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:COLLEEN
Last Name:KRISTOFIC
Suffix:
Gender:F
Credentials:MAED, PPS, BCBA
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:COLLEEN
Other - Last Name:RAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAED, PPS, BCBA
Mailing Address - Street 1:969 S VILLAGE OAKS DR
Mailing Address - Street 2:SUITE #204
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-0605
Mailing Address - Country:US
Mailing Address - Phone:909-621-0713
Mailing Address - Fax:866-579-6146
Practice Address - Street 1:969 S VILLAGE OAKS DR
Practice Address - Street 2:SUITE #204
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-0605
Practice Address - Country:US
Practice Address - Phone:909-621-0713
Practice Address - Fax:866-579-6146
Is Sole Proprietor?:No
Enumeration Date:2014-09-27
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9303103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst