Provider Demographics
NPI:1396349593
Name:FAALEPO, CHARVET MANAIA
Entity type:Individual
Prefix:MISS
First Name:CHARVET
Middle Name:MANAIA
Last Name:FAALEPO
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 1:605 PLAZA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3502
Mailing Address - Country:US
Mailing Address - Phone:209-605-3868
Mailing Address - Fax:
Practice Address - Street 1:605 PLAZA DEL SOL
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3502
Practice Address - Country:US
Practice Address - Phone:209-605-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician