Healthcare Provider Details

I. General information

NPI: 1740135268
Provider Name (Legal Business Name): GIOVANI ENRIQUE VAQUERANO BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 LONG BEACH BLVD
LONG BEACH CA
90807-3340
US

IV. Provider business mailing address

3745 LONG BEACH BLVD
LONG BEACH CA
90807-3340
US

V. Phone/Fax

Practice location:
  • Phone: 310-787-9334
  • Fax:
Mailing address:
  • Phone: 310-787-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: