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General NPI Number Information
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NPI Number | 1932688330
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Entity Type | Individual
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Provider Name | ANALIS MARIA MORON MIRANDA BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 11022 SANTA MONICA BLVD STE 120
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City | LOS ANGELES
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State | CA
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Zip | 90025-7566
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Country | US
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Telephone | 626-755-0089
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Fax |
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Provider Business Mailing Address
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Address Line | 9224 BROOKSHIRE AVE APT 12
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City | DOWNEY
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State | CA
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Zip | 90240-2951
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Country | US
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Telephone | 562-746-0146
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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 | 1-18-30502
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License Number State | CA
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