MEDICARE: BRIANNA ALINA VELASCO MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103K00000X	Behavior Analyst	CA
2	171M00000X	Case Manager/Care Coordinator
3	106S00000X	Behavior Technician	CA

General Provider Information

NPI Number	:	1902462096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA ALINA VELASCO MARTINEZ

Provider Business Mailing Address
First Line	:	21600 OXNARD ST STE 1800
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7807
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 W MINERAL KING AVE
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5531
Country	:	US
Telephone Number	:	559-825-8455
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	06/20/2022

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