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General NPI Number Information
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NPI Number | 1114663515
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Entity Type | Organization
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Legal Business Name | LA RAIZ BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 5239 HARMONY AVE APT 306
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City | N HOLLYWOOD
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State | CA
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Zip | 91601-5536
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Country | US
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Telephone | 818-749-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 W BURBANK BLVD # 7003
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City | BURBANK
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State | CA
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Zip | 91506-1315
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Country | US
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Telephone | 818-749-2263
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSE RIOS
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Credential | BCBA
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Telephone | 818-749-2263
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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 |
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License Number State |
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