Healthcare Provider Details

I. General information

NPI: 1720828809
Provider Name (Legal Business Name): GABRIELLE VERDUZCO BCBA, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 S CENTRAL ST
VISALIA CA
93277-4418
US

IV. Provider business mailing address

1830 S CENTRAL ST
VISALIA CA
93277-4418
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-2969
  • Fax: 559-730-2991
Mailing address:
  • Phone: 559-730-2969
  • Fax: 559-730-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42716
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: