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General NPI Number Information
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NPI Number | 1275495111
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Entity Type | Individual
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Provider Name | MR. TRAVIS JAMES ROSS
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Gender | Male
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 195 S BROADWAY ST STE 205
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City | ORCUTT
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State | CA
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Zip | 93455-4656
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Country | US
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Telephone | 805-552-5239
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Fax |
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Provider Business Mailing Address
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Address Line | 461 BALD EAGLE DR
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City | VACAVILLE
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State | CA
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Zip | 95688-1019
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Country | US
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Telephone | 707-400-9305
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-7939-885985
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License Number State | CA
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