Healthcare Provider Details

I. General information

NPI: 1306305479
Provider Name (Legal Business Name): LOURDES CEJAACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 STUDEBAKER RD STE 700
CERRITOS CA
90703-2684
US

IV. Provider business mailing address

13502 WHITTIER BLVD # H145
WHITTIER CA
90605-1945
US

V. Phone/Fax

Practice location:
  • Phone: 562-322-2415
  • Fax: 207-209-7681
Mailing address:
  • Phone: 562-322-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12153567
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: