Healthcare Provider Details

I. General information

NPI: 1306304100
Provider Name (Legal Business Name): MARA BETHANY FELIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 CANOGA AVE FL 15
WOODLAND HILLS CA
91367-2563
US

IV. Provider business mailing address

400 CONTINENTAL BLVD FL 6
EL SEGUNDO CA
90245-5074
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 310-310-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number10250
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: