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General NPI Number Information
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NPI Number | 1730909334
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Entity Type | Individual
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Provider Name | EFREN FUENTES M.A., BCBA
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Gender | Male
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 5967 W 3RD ST
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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 | 501 W FERNFIELD DR
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City | MONTEREY PARK
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State | CA
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Zip | 91754-7002
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Country | US
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Telephone | 323-712-1421
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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 | 1-24-72291
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License Number State | CA
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