Healthcare Provider Details

I. General information

NPI: 1285258301
Provider Name (Legal Business Name): MEGAN BETH ORDONEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 57TH ST
SACRAMENTO CA
95819-3328
US

IV. Provider business mailing address

922 57TH ST
SACRAMENTO CA
95819-3328
US

V. Phone/Fax

Practice location:
  • Phone: 916-228-4169
  • Fax:
Mailing address:
  • Phone: 916-228-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42749
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB347077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: