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NPI Code Detail

MEDICARE: TAI YUSTAT BCBA

MEDICARE: TAI YUSTAT BCBA
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
1103K00000XBehavior Analyst1-17-28517CA

General Provider Information

NPI Number : 1467953596
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAI YUSTAT BCBA
Provider Business Mailing Address
First Line : 4980 HILLSDALE CIR STE B
Second Line :
City : EL DORADO HILLS
State : CA
Zip : 95762-5726
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4980 HILLSDALE CIR STE B
Second Line :
City : EL DORADO HILLS
State : CA
Zip : 95762-5726
Country : US
Telephone Number : 916-693-6469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2018
Last Update Date : 01/01/2026

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