Healthcare Provider Details

I. General information

NPI: 1003314642
Provider Name (Legal Business Name): GEORGINA NGUYEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 BLOSSOM HILL RD STE 201
SAN JOSE CA
95123-1655
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 408-423-8076
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA1-21-52185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: