Healthcare Provider Details

I. General information

NPI: 1083199723
Provider Name (Legal Business Name): KATELYN ANNE ZISSIMOS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41593 WINCHESTER RD STE 200
TEMECULA CA
92590-4857
US

IV. Provider business mailing address

41760 IVY ST STE 101
MURRIETA CA
92562-9416
US

V. Phone/Fax

Practice location:
  • Phone: 951-216-3330
  • Fax:
Mailing address:
  • Phone: 951-595-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-66888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: