Healthcare Provider Details

I. General information

NPI: 1538017033
Provider Name (Legal Business Name): BCABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 SUNNY SKY LN SW
ALBUQUERQUE NM
87121-2617
US

IV. Provider business mailing address

7108 SOUTH KANNER HWY, STUART, FL
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-9137
  • Fax:
Mailing address:
  • Phone: 855-832-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YAMILETH J MADRID
Title or Position: BCABA
Credential:
Phone: 505-304-9137