Healthcare Provider Details

I. General information

NPI: 1780175992
Provider Name (Legal Business Name): SUSANA PINZON BEHAVIOR ANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 STANDIFORD AVE STE B
MODESTO CA
95350-1000
US

IV. Provider business mailing address

350 FAIRWAY DR STE 101
DEERFIELD BEACH FL
33441-1834
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax: 954-947-3756
Mailing address:
  • Phone: 888-880-9270
  • Fax: 954-342-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-40311
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: