MEDICARE: RIMA KLIORE-FREDERICKSON MS, 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1801153903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIMA KLIORE-FREDERICKSON MS, BCBA

Provider Business Mailing Address
First Line	:	2344 JUAN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1111
Country	:	US
Telephone Number	:	858-336-1020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2344 JUAN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1111
Country	:	US
Telephone Number	:	858-336-1020
Fax Number	:

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

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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