Healthcare Provider Details

I. General information

NPI: 1073101374
Provider Name (Legal Business Name): PARAGON ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 RIVERSIDE BLVD APT 203
SACRAMENTO CA
95831-1330
US

IV. Provider business mailing address

PO BOX 221433
SACRAMENTO CA
95822-8433
US

V. Phone/Fax

Practice location:
  • Phone: 661-333-1981
  • Fax:
Mailing address:
  • Phone: 661-333-1981
  • 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: ANTONIO PENUELAS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: BCBA
Phone: 661-333-1981