Healthcare Provider Details

I. General information

NPI: 1487272092
Provider Name (Legal Business Name): ADRIENNE PAGLINAWAN M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24516 NARBONNE AVE APT B
LOMITA CA
90717-1189
US

IV. Provider business mailing address

24516 NARBONNE AVE APT B
LOMITA CA
90717-1189
US

V. Phone/Fax

Practice location:
  • Phone: 310-940-7739
  • Fax:
Mailing address:
  • Phone: 310-940-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67682
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: