MEDICARE: REGAN NICOLE TULLIS

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
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1780250878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGAN NICOLE TULLIS

Provider Business Mailing Address
First Line	:	18726 S WESTERN AVE
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3813
Country	:	US
Telephone Number	:	310-856-0800
Fax Number	:	855-568-2494

Provider Business Practice Location Address
First Line	:	4700 SPRING ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-0263
Country	:	US
Telephone Number	:	619-782-0700
Fax Number	:	619-782-0710

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

Provider Enumeration Date	:	05/31/2021
Last Update Date	:	03/24/2026

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Directions to “ REGAN NICOLE TULLIS ” Practice Location

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