Healthcare Provider Details

I. General information

NPI: 1891247367
Provider Name (Legal Business Name): DIANA SEVILLANOS-MYERS BCBA, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15311 CUDA DR
BAKERSFIELD CA
93307-9280
US

IV. Provider business mailing address

15311 CUDA DR
BAKERSFIELD CA
93307-9280
US

V. Phone/Fax

Practice location:
  • Phone: 661-213-6084
  • Fax:
Mailing address:
  • Phone: 661-213-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1600005457
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-15040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: