MEDICARE: NEIRA MARIANA ESTERWOLD MS

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	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1053037754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIRA MARIANA ESTERWOLD MS

Provider Business Mailing Address
First Line	:	278 HYDRANGEA ST
Second Line	:
City	:	FILLMORE
State	:	CA
Zip	:	93015-1897
Country	:	US
Telephone Number	:	805-317-9556
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 BEHAVIORAL HEALTH 16380 ROSCOE BLVD. STE 100
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406
Country	:	US
Telephone Number	:	747-221-4197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	12/01/2025

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