Basic Information
| Provider Information | |||||||||
| NPI: | 1710551296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITTANTE | ||||||||
| FirstName: | RAECHEL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 S EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917626620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099835575 | ||||||||
| FaxNumber: | 9099831076 | ||||||||
| Practice Location | |||||||||
| Address1: | 21660 COPLEY DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | DIAMOND BAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917654109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093966668 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2021 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 124761 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.