=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013474485
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW DANIEL CABANILLAS RBT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2019
-----------------------------------------------------
Last Update Date | 02/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2741 S 8TH AVE STE C
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-7154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-782-1338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10362 E 39TH PL
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85365-7234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-919-3983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-19-77750
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------