Healthcare Provider Details

I. General information

NPI: 1831705342
Provider Name (Legal Business Name): PAULISHA MICHELLE BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST
GARDENA CA
90248-4220
US

IV. Provider business mailing address

879 W 190TH ST STE 100
GARDENA CA
90248-4223
US

V. Phone/Fax

Practice location:
  • Phone: 310-819-4523
  • Fax:
Mailing address:
  • Phone: 310-819-4523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: