Chanel Antenorcruz Acosta
Individual provider Active NPI Behavior Technician · Fremont, CA
NPI 1821673997 · NPPES record last updated Mar 10, 2021
Key facts
- NPI
- 1821673997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- 46-1305562 (CA)
- Practice address
- 39210 State St Ste 204
Fremont, CA 94538-1456 - Phone
- (510) 894-4135
- NPI assigned
- Mar 10, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46-1305562 | CA | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 46-1305562 | CA | Yes |
Addresses
Primary practice location
39210 State St Ste 204
Fremont, CA 94538-1456
Mailing address
3830 Northumberland Ter
Fremont, CA 94555-2262
Phone (510) 320-8675
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- Cerjio Aceves
- Kranthi Kumar Achanta
- Suselina Acosta-Goldstein
- Elizabeth Acosta
- Act Acupuncture Clinic Corp
- Acuharmony Inc
- Acumed Acupuncture Inc.
- Acupuncture Healthcare Clinic of Fremont, Inc.
All providers in Fremont, CA · Behavior Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.