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General NPI Number Information
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NPI Number | 1568958387
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Entity Type | Individual
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Provider Name | GILBERT JOSEPH MENCHACA BCBA
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Gender | Male
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 5967 W 3RD ST STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90036-2835
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Country | US
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Telephone | 323-745-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 11115 AQUA VISTA ST APT 306
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-3722
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Country | US
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Telephone | 323-379-8400
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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 | 1-18-30959
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License Number State | CA
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