Fultz, Travis Dauntia
Fultz, Travis Dauntia is an individual health care provider with primary practice located at 13193 Central Avenue Suite 200, Chino CA 91710. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Fultz, Travis Dauntia can be contacted via phone (909) 902-9111.Contact Information
Primary practice address
13193 Central Avenue Suite 200
Chino CA 91710
Phone: (909) 902-9111
Fax: (909) 902-9199
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | PSY 19419 | California |
Profile Details
| NPI number | 1831171388 |
|---|---|
| LBN Legal business name | Fultz, Travis Dauntia |
| Credentials | PSYD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 18th, 2005 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831171388 | NPPES |
| California | MEDICAID | PSY 194190 |
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