Healthcare Provider Details

I. General information

NPI: 1396203469
Provider Name (Legal Business Name): ANESSA LEE TRUJILLO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 MARBER AVE
LONG BEACH CA
90815-1137
US

IV. Provider business mailing address

8824 19TH ST APT 48
RANCHO CUCAMONGA CA
91701-4600
US

V. Phone/Fax

Practice location:
  • Phone: 562-377-1027
  • Fax:
Mailing address:
  • Phone: 626-221-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: