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General NPI Number Information
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NPI Number | 1811699515
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Entity Type | Individual
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Provider Name | MS. IVY ROSE JOSE ANDO
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 8123 SHELDON RD APT 206
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City | ELK GROVE
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State | CA
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Zip | 95758-1270
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Country | US
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Telephone | 805-332-6075
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 E CLARK AVE SPC 122
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City | SANTA MARIA
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State | CA
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Zip | 93455-7511
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Country | US
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Telephone | 805-332-6075
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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 | 1-24-78693
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-207355
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License Number State | CA
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