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General NPI Number Information
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NPI Number | 1104498476
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Entity Type | Individual
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Provider Name | MARINA D BAUTISTA BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 7827 FLORENCE AVE
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City | DOWNEY
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State | CA
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Zip | 90240-3727
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Country | US
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Telephone | 310-374-3300
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Fax | 310-374-3307
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Provider Business Mailing Address
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Address Line | 119 W TORRANCE BLVD STE 100
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3600
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Country | US
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Telephone | 310-374-3300
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Fax | 310-374-3307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-21-55796
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License Number State | CA
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