Provider Demographics
NPI:1871094029
Name:MATILLANO, ANA VANESSA CALPITO
Entity type:Individual
Prefix:
First Name:ANA VANESSA
Middle Name:CALPITO
Last Name:MATILLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 W FALMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-7713
Mailing Address - Country:US
Mailing Address - Phone:310-602-9201
Mailing Address - Fax:
Practice Address - Street 1:2390 E ORANGEWOOD AVE STE 400
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6139
Practice Address - Country:US
Practice Address - Phone:714-468-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst