Healthcare Provider Details

I. General information

NPI: 1891504916
Provider Name (Legal Business Name): ABA 4 FRIENDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 W CANCUN DR
IMPERIAL CA
92251-8862
US

IV. Provider business mailing address

266 W CANCUN DR
IMPERIAL CA
92251-8862
US

V. Phone/Fax

Practice location:
  • Phone: 760-693-9050
  • Fax:
Mailing address:
  • Phone: 760-693-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL ANGEL MEZA
Title or Position: CO-FOUNDER
Credential:
Phone: 760-693-9050