Provider Demographics
NPI:1992130603
Name:CAPP, KRISTA KAY (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:KAY
Last Name:CAPP
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 HAVEN AVE # 179
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6064
Mailing Address - Country:US
Mailing Address - Phone:951-252-4634
Mailing Address - Fax:
Practice Address - Street 1:7211 HAVEN AVE # 179
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-6064
Practice Address - Country:US
Practice Address - Phone:951-252-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst