Provider Demographics
NPI:1568868461
Name:CHUMPITAZI, BRENT DAVID (MS)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DAVID
Last Name:CHUMPITAZI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17692 BEACH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6851
Mailing Address - Country:US
Mailing Address - Phone:714-487-8320
Mailing Address - Fax:714-254-8480
Practice Address - Street 1:17692 BEACH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6851
Practice Address - Country:US
Practice Address - Phone:714-487-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist