Healthcare Provider Details

I. General information

NPI: 1992100812
Provider Name (Legal Business Name): JOSE PRADO ROJAS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 W WHITENDALE AVE SUITE B, #4
VISALIA CA
93277-6131
US

IV. Provider business mailing address

PO BOX 25042
FRESNO CA
93729-5042
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-1245
  • Fax:
Mailing address:
  • Phone: 559-438-1245
  • Fax: 559-261-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: