Healthcare Provider Details

I. General information

NPI: 1073342218
Provider Name (Legal Business Name): NOR ABACA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 3RD ST # 209
BURBANK CA
91502-1107
US

IV. Provider business mailing address

300 N 3RD ST STE 209
BURBANK CA
91502-1107
US

V. Phone/Fax

Practice location:
  • Phone: 667-216-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MARIAM LAURENNE DAVTYAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 667-216-1222