Healthcare Provider Details

I. General information

NPI: 1922999622
Provider Name (Legal Business Name): RAVERON BEHAVIORAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DOYLE DR UNIT B
SAN GABRIEL CA
91775-2851
US

IV. Provider business mailing address

420 DOYLE DR UNIT B
SAN GABRIEL CA
91775-2851
US

V. Phone/Fax

Practice location:
  • Phone: 626-225-0069
  • Fax:
Mailing address:
  • Phone: 626-225-0069
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: XIAOJIN LIN
Title or Position: CLINICAL SUPERVISOR
Credential: BCBA., MS, LBA, MBA
Phone: 213-421-2934