Healthcare Provider Details

I. General information

NPI: 1427552199
Provider Name (Legal Business Name): MONICA HARUNA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 GALILEO CT STE 101
DAVIS CA
95618
US

IV. Provider business mailing address

120 THERESA AVE
AMERICAN CANYON CA
94503-9654
US

V. Phone/Fax

Practice location:
  • Phone: 916-266-3972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-11282
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-31071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: