=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245568856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA CHAN BCABA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2009
-----------------------------------------------------
Last Update Date | 11/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2907 NETWORK PL APT. 204D
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-870-4584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2907 NETWORK PL APT. 204D
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33559-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-870-4584
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 0-09-3582
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------