Healthcare Provider Details

I. General information

NPI: 1114486685
Provider Name (Legal Business Name): JODY QUYNH NGUYEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 N BATAVIA ST STE 120
ORANGE CA
92867-3525
US

IV. Provider business mailing address

2063 S SPRUCE ST
SANTA ANA CA
92704-4833
US

V. Phone/Fax

Practice location:
  • Phone: 657-456-8558
  • Fax: 833-256-3911
Mailing address:
  • Phone: 657-456-8558
  • Fax: 833-256-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39399
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: