Healthcare Provider Details

I. General information

NPI: 1699697110
Provider Name (Legal Business Name): BEHAVIOR FRONTIERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N PACIFIC COAST HWY STE 1400
EL SEGUNDO CA
90245-5602
US

IV. Provider business mailing address

PO BOX 4903
OCEANSIDE CA
92052-4903
US

V. Phone/Fax

Practice location:
  • Phone: 888-922-2843
  • Fax:
Mailing address:
  • Phone: 760-859-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA JOLIE BURBANK
Title or Position: BEHAVIORAL TECHNICIAN
Credential:
Phone: 760-859-6576