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NPI Code Detail

MEDICARE: GWENDOLYN JENNIFER-MCCLAVE ASHOKKUMAR

MEDICARE: GWENDOLYN JENNIFER-MCCLAVE ASHOKKUMAR
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 Analyst1-14-16435CA
2103K00000XBehavior Analyst9302TX

General Provider Information

NPI Number : 1710382981
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN JENNIFER-MCCLAVE ASHOKKUMAR
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 16360 ROSCOE BLVD STE 100
Second Line :
City : VAN NUYS
State : CA
Zip : 91406-1206
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2014
Last Update Date : 11/10/2025

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Directions to “ GWENDOLYN JENNIFER-MCCLAVE ASHOKKUMAR ” Practice Location

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