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General NPI Number Information
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NPI Number | 1518890805
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Entity Type | Individual
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Provider Name | ELLIOT NICOLE CAVANAUGH
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Gender | Female
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 34448 YUCAIPA BLVD STE A
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City | YUCAIPA
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State | CA
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Zip | 92399-2412
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Country | US
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Telephone | 909-353-7547
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Fax |
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Provider Business Mailing Address
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Address Line | 38207 POTATO CANYON RD
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City | OAK GLEN
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State | CA
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Zip | 92399-9554
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Country | US
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Telephone | 949-444-6225
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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 |
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License Number State | CA
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