Healthcare Provider Details

I. General information

NPI: 1437065141
Provider Name (Legal Business Name): MR. VINCENT MOSES GAPUZ EDRALIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DJ EDRALIN

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14109 S BUDLONG AVE
GARDENA CA
90247-2231
US

IV. Provider business mailing address

14109 S BUDLONG AVE
GARDENA CA
90247-2231
US

V. Phone/Fax

Practice location:
  • Phone: 310-227-9499
  • Fax:
Mailing address:
  • Phone: 310-227-9499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: