Healthcare Provider Details

I. General information

NPI: 1366922171
Provider Name (Legal Business Name): MATTHEW DAVID JANKOWSKI BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W SLAUSON AVE STE 130
CULVER CITY CA
90230-6576
US

IV. Provider business mailing address

550 PAULARINO AVE APT D105
COSTA MESA CA
92626-3220
US

V. Phone/Fax

Practice location:
  • Phone: 310-910-0406
  • Fax:
Mailing address:
  • Phone: 714-654-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47084
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: