Basic Information
| Provider Information | |||||||||
| NPI: | 1104435619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHHITH | ||||||||
| FirstName: | CHHARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1556 S SULTANA AVE | ||||||||
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| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917614238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094186923 | ||||||||
| FaxNumber: | 9094186937 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 CENTER COURT DR | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917243613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268592089 | ||||||||
| FaxNumber: | 6268596537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2020 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 110217 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.