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General NPI Number Information
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NPI Number | 1962859298
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Entity Type | Organization
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Legal Business Name | JOANNA LEAL
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 16792 TALISMAN LN APT 205
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-3118
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Country | US
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Telephone | 415-741-8643
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Fax |
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Provider Business Mailing Address
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Address Line | 16792 TALISMAN LN APT 205
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-3118
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Country | US
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Telephone | 415-741-8643
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | JOANNA LEAL
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Credential | BCBA
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Telephone | 415-741-8643
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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 | 1-13-14386
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License Number State | CA
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