Healthcare Provider Details

I. General information

NPI: 1699170068
Provider Name (Legal Business Name): SAMYUKTHA KASHINATH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 06/25/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 PALOMAR AIRPORT RD
CARLSBAD CA
92011-1423
US

IV. Provider business mailing address

2141 PALOMAR AIRPORT RD
CARLSBAD CA
92011-1423
US

V. Phone/Fax

Practice location:
  • Phone: 760-710-2460
  • Fax: 855-864-1491
Mailing address:
  • Phone: 760-710-2460
  • Fax: 855-864-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: