Provider Demographics
NPI:1619760071
Name:FAVELA, KACEY
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:FAVELA
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 1:2200 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1043
Mailing Address - Country:US
Mailing Address - Phone:323-671-9287
Mailing Address - Fax:
Practice Address - Street 1:2201 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3804
Practice Address - Country:US
Practice Address - Phone:800-883-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician