Healthcare Provider Details

I. General information

NPI: 1184585986
Provider Name (Legal Business Name): EM L MAWI RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 N MAGNOLIA AVE
EL CAJON CA
92020-3908
US

IV. Provider business mailing address

1445 BROADWAY APT 20
EL CAJON CA
92021-5186
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-8923
  • Fax: 858-649-6012
Mailing address:
  • Phone: 484-929-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-492882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: