Healthcare Provider Details

I. General information

NPI: 1114720828
Provider Name (Legal Business Name): LUIS FERREYRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 GORDON LN
SANTA ROSA CA
95404-5636
US

IV. Provider business mailing address

1120 GORDON LN
SANTA ROSA CA
95404-5636
US

V. Phone/Fax

Practice location:
  • Phone: 707-527-3249
  • Fax:
Mailing address:
  • Phone: 707-527-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: