Healthcare Provider Details

I. General information

NPI: 1194317784
Provider Name (Legal Business Name): MARIELA CISNEROS MAGANA M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 OLD CONEJO RD STE 202
THOUSAND OAKS CA
91320-2153
US

IV. Provider business mailing address

3255 OLD CONEJO RD STE 202
THOUSAND OAKS CA
91320-2153
US

V. Phone/Fax

Practice location:
  • Phone: 805-254-6249
  • Fax: 855-568-2494
Mailing address:
  • Phone: 805-254-6249
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: