Healthcare Provider Details

I. General information

NPI: 1407403272
Provider Name (Legal Business Name): CHRISTINA SUAREZ LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE STE 6007
TACOMA WA
98405-1702
US

IV. Provider business mailing address

PO BOX 767938
ROSWELL GA
30076-7938
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 800-819-7806
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberAB61024538
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-94880
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61127069
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: