Healthcare Provider Details

I. General information

NPI: 1033610498
Provider Name (Legal Business Name): NEGAR GHORBANALI MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 W 5TH ST STE 2613
LOS ANGELES CA
90071-2005
US

IV. Provider business mailing address

1221 GEORGINA AVE
SANTA MONICA CA
90402-2119
US

V. Phone/Fax

Practice location:
  • Phone: 310-621-3458
  • Fax:
Mailing address:
  • Phone: 310-621-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: