Provider Demographics
NPI:1427859503
Name:CHATA, MARISA
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:CHATA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26377 RAINBOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1396
Mailing Address - Country:US
Mailing Address - Phone:661-860-2990
Mailing Address - Fax:
Practice Address - Street 1:28245 AVENUE CROCKER STE 220
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1201
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician