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Provider Information for 1891257044

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1891257044

Calendar   Last Updated:  2019-04-04
  Certification Date: 


Name Value
NPI 1891257044
Enumeration Date 2019-04-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 16782 VON KARMAN AVE STE 11
IRVINE, CA 92606-2417
United States

Phone: 949-833-2237 | Fax:
View Map External Link
Primary Practice Address 3731 6TH AVE STE 100
SAN DIEGO, CA 92103-4383
United States

Phone: 619-278-0884 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 106S00000X - Behavior Technician