MEDICARE: MIRIAM BURROLA TAPIA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1780536771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM BURROLA TAPIA

Provider Business Mailing Address
First Line	:	100 N PACIFIC COAST HWY STE 1400
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-5602
Country	:	US
Telephone Number	:	949-357-2556
Fax Number	:	949-357-2556

Provider Business Practice Location Address
First Line	:	9065 HAVEN AVE STE 102
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-5429
Country	:	US
Telephone Number	:	951-357-6926
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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