Healthcare Provider Details

I. General information

NPI: 1073141610
Provider Name (Legal Business Name): IRMA ELISA CANELA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 BEGONIA DR
BRENTWOOD CA
94513-5492
US

IV. Provider business mailing address

792 BEGONIA DR
BRENTWOOD CA
94513-5492
US

V. Phone/Fax

Practice location:
  • Phone: 925-732-8161
  • Fax:
Mailing address:
  • Phone: 925-732-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2849929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: