Healthcare Provider Details

I. General information

NPI: 1316829864
Provider Name (Legal Business Name): AURORA MADISON BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST
LA MESA CA
91942-0263
US

IV. Provider business mailing address

2019 ELVA ST
EL CAJON CA
92019-4167
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone: 619-633-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-453739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: