Healthcare Provider Details

I. General information

NPI: 1215497946
Provider Name (Legal Business Name): KAITLYN PIETROBONO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/29/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 E LA PALMA AVE SUITE A
ANAHEIM CA
92806
US

IV. Provider business mailing address

13501 CANYON VIEW DR
YUCAIPA CA
92399-5809
US

V. Phone/Fax

Practice location:
  • Phone: 714-912-5139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59036
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: