Healthcare Provider Details

I. General information

NPI: 1427544311
Provider Name (Legal Business Name): MARNI PAGE ELLWOOD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPORT RD STE 350
CARLSBAD CA
92011-1451
US

IV. Provider business mailing address

625 S FIG ST APT 6
ESCONDIDO CA
92025-4440
US

V. Phone/Fax

Practice location:
  • Phone: 760-438-0078
  • Fax:
Mailing address:
  • Phone: 609-276-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56414
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-39386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: