Healthcare Provider Details

I. General information

NPI: 1366840977
Provider Name (Legal Business Name): BRENDA MONTERDE BCBA AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PLAZA DR BLDG A UNIT 5
SANTA MARIA CA
93454-6931
US

IV. Provider business mailing address

15315 MAGNOLIA BLVD STE 428
SHERMAN OAKS CA
91403-1173
US

V. Phone/Fax

Practice location:
  • Phone: 805-273-6556
  • Fax: 844-884-4677
Mailing address:
  • Phone: 888-603-7779
  • Fax: 844-884-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1-14-16087
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-14-16087
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-14-16087
License Number StateCA

VIII. Authorized Official

Name: MISS BRENDA PAOLA MONTERDE
Title or Position: PRESIDENT/ DIRECTOR OF CLINICAL SER
Credential: M.A BCBA
Phone: 818-406-2103