MEDICARE: MARIA ELENA BRAMBILA 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	1-22-60482	CA
2	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-22-60482	OTHER	CA	BCBA

General Provider Information

NPI Number	:	1851896328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELENA BRAMBILA MS. BCBA

Provider Business Mailing Address
First Line	:	1018 MADDIE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-2184
Country	:	US
Telephone Number	:	619-410-8052
Fax Number	:

Provider Business Practice Location Address
First Line	:	2338 W ROYAL PALM RD STE J
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9339
Country	:	US
Telephone Number	:	248-220-7980
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	02/04/2026

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