Healthcare Provider Details

I. General information

NPI: 1770085359
Provider Name (Legal Business Name): ANA CRISTINA MUNGUIA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE STE 200B
WESTMINSTER CA
92683-2939
US

IV. Provider business mailing address

7525 WESTERN AVE
BUENA PARK CA
90620-1812
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 714-421-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41199
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-36178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: