Healthcare Provider Details

I. General information

NPI: 1073136669
Provider Name (Legal Business Name): YAJAIRA LISSET RUBIO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARK GRANADA STE 202
CALABASAS CA
91302-1666
US

IV. Provider business mailing address

4500 PARK GRANADA STE 202
CALABASAS CA
91302-1666
US

V. Phone/Fax

Practice location:
  • Phone: 818-932-9644
  • Fax: 818-600-1102
Mailing address:
  • Phone: 818-932-9644
  • Fax: 818-600-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: