Healthcare Provider Details

I. General information

NPI: 1518890805
Provider Name (Legal Business Name): ELLIOT NICOLE CAVANAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34448 YUCAIPA BLVD STE A
YUCAIPA CA
92399-2412
US

IV. Provider business mailing address

38207 POTATO CANYON RD
OAK GLEN CA
92399-9554
US

V. Phone/Fax

Practice location:
  • Phone: 909-353-7547
  • Fax:
Mailing address:
  • Phone: 949-444-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: