Healthcare Provider Details

I. General information

NPI: 1700331113
Provider Name (Legal Business Name): JULIA ELENA DAVILA MACIAS M.A., M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA ELENA VALLEJO

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W 190TH ST
GARDENA CA
90248-4324
US

IV. Provider business mailing address

1501 W CAMERON AVE STE 215
WEST COVINA CA
91790-2724
US

V. Phone/Fax

Practice location:
  • Phone: 310-719-3908
  • Fax:
Mailing address:
  • Phone: 323-302-9997
  • Fax: 818-736-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67265
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: