Provider Demographics
NPI:1699551622
Name:A DETAR, JAMES A
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:A DETAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20259 VENTURA BLVD # 259A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2551
Mailing Address - Country:US
Mailing Address - Phone:747-249-1127
Mailing Address - Fax:
Practice Address - Street 1:39510 PASEO PADRE PKWY STE 190
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4716
Practice Address - Country:US
Practice Address - Phone:510-403-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician