Healthcare Provider Details

I. General information

NPI: 1578157194
Provider Name (Legal Business Name): FREDDY A. GAVARRETE BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 S WESTGATE AVE
LOS ANGELES CA
90025-6118
US

IV. Provider business mailing address

400 CORPORATE POINTE STE 300
CULVER CITY CA
90230-7620
US

V. Phone/Fax

Practice location:
  • Phone: 310-899-9597
  • Fax: 310-943-2258
Mailing address:
  • Phone: 626-340-7041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59530
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00013111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: