MEDICARE: DRSELENA

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	1-04-1851	CA

General Provider Information

NPI Number	:	1922362938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRSELENA

Provider Business Mailing Address
First Line	:	27 NEW YORK CT
Second Line	:
City	:	MONARCH BEACH
State	:	CA
Zip	:	92629-4524
Country	:	US
Telephone Number	:	949-528-5013
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 NEW YORK CT
Second Line	:
City	:	MONARCH BEACH
State	:	CA
Zip	:	92629-4524
Country	:	US
Telephone Number	:	949-528-5013
Fax Number	:

Authorized Official
Title or Position	:	OWNER / CLINICAL DIRECTOR
Name	:	DR. SELENA ROSE EMOND
Credential	:	PHD, BCBA-D
Telephone Number	:	949-338-2995

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	02/23/2017

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