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General NPI Number Information
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NPI Number | 1154821171
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Entity Type | Individual
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Provider Name | JOHN ERICK MADRID LASCANO
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 200 E. DEL MAR BLVD SUITE 112
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City | PASADENA
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State | CA
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Zip | 91105
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Country | US
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Telephone | 949-203-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 295 89TH ST SUITE 306
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City | DALY CITY
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State | CA
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Zip | 94015
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Country | US
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Telephone | 877-264-6747
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Fax |
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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 |
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License Number State |
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