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NPI Code Detail

MEDICARE: MS. CHRISTINA PANTELOGLOW BCBA, LBA

MEDICARE: MS. CHRISTINA PANTELOGLOW BCBA, LBA
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
1103K00000XBehavior Analyst1-22-57666CA

General Provider Information

NPI Number : 1962905414
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHRISTINA PANTELOGLOW BCBA, LBA
Provider Business Mailing Address
First Line : 3620 SPENCEVILLE RD
Second Line :
City : WHEATLAND
State : CA
Zip : 95692-9754
Country : US
Telephone Number : 916-581-3652
Fax Number :
Provider Business Practice Location Address
First Line : 2 N CENTRAL AVE STE 1800
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-2139
Country : US
Telephone Number : 602-807-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2018
Last Update Date : 11/23/2022

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