Healthcare Provider Details

I. General information

NPI: 1437757903
Provider Name (Legal Business Name): NATALIE COSTILLA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 MISSION VALLEY RD STE 200
SAN DIEGO CA
92108-4438
US

IV. Provider business mailing address

7592 METROPOLITAN DR STE 404
SAN DIEGO CA
92108-4428
US

V. Phone/Fax

Practice location:
  • Phone: 858-304-6440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: