Healthcare Provider Details

I. General information

NPI: 1992405542
Provider Name (Legal Business Name): ABANZE BEHAVIOR INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N HILL PL APT 307
LOS ANGELES CA
90012-3055
US

IV. Provider business mailing address

440 N BARRANCA AVE # 9555
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 951-892-5140
  • Fax:
Mailing address:
  • Phone: 951-892-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: AIME M GUTIERREZ
Title or Position: OWNER
Credential:
Phone: 951-892-5140