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General NPI Number Information
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NPI Number | 1811507536
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Entity Type | Individual
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Provider Name | ROSANA BAUTISTA M.S., BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 4401 CRENSHAW BLVD STE 215
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City | LOS ANGELES
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State | CA
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Zip | 90043-1200
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Country | US
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Telephone | 310-661-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 4204 E SAN VINCENTE ST
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City | COMPTON
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State | CA
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Zip | 90221-2463
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Country | US
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Telephone | 310-661-0555
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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 | 1-25-79875
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License Number State | CA
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