Healthcare Provider Details

I. General information

NPI: 1235454364
Provider Name (Legal Business Name): MARCELA PERDOMO BCBA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 WAKE AVE STE 1
EL CENTRO CA
92243-7500
US

IV. Provider business mailing address

603 WAKE AVE STE 1
EL CENTRO CA
92243-7500
US

V. Phone/Fax

Practice location:
  • Phone: 760-919-2100
  • Fax: 760-301-9688
Mailing address:
  • Phone: 760-919-2100
  • Fax: 760-301-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: