MEDICARE: DR C B CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-07-3465

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-07-3465	OTHER		BEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number	:	1023532561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR C B CONSULTING

Provider Business Mailing Address
First Line	:	7190 W SUNSET BLVD # 1070
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4415
Country	:	US
Telephone Number	:	877-383-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	7190 W SUNSET BLVD # 1070
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4415
Country	:	US
Telephone Number	:	877-383-1038
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CYNTHIA BOYLE
Credential	:
Telephone Number	:	877-383-1038

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	06/16/2018

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