Healthcare Provider Details

I. General information

NPI: 1679837843
Provider Name (Legal Business Name): ROBYNNE MICHELLE BUMP BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYNNE MICHELLE WITHROW

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 LINCOLN AVE D
SAN JOSE CA
95125-3513
US

IV. Provider business mailing address

505 N BRAND BLVD STE 1000
GLENDALE CA
91203-3924
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 818-241-6853
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-24667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: