Individual
AZURE CHAMPLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2928 JEFFERSON ST STE 100, CARLSBAD, CA 92008-2374
(855) 223-7123
(619) 374-7134
Mailing address
PO BOX 33568, SAN DIEGO, CA 92163-3568
(855) 223-7123
(619) 374-7134
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0134000142
VA
Other
Enumeration date
04/21/2016
Last updated
04/23/2024
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