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NPI Code Detail

MEDICARE: RANDY ENCISO

MEDICARE: RANDY ENCISO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner
2103K00000XBehavior Analyst1-18-32353CA

General Provider Information

NPI Number : 1003139890
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDY ENCISO
Provider Business Mailing Address
First Line : 965 W SIERRA MADRE AVE
Second Line : APT. #2
City : AZUSA
State : CA
Zip : 91702-1836
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5554 RESEDA BLVD STE 203
Second Line :
City : TARZANA
State : CA
Zip : 91356-6212
Country : US
Telephone Number : 818-705-5522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2010
Last Update Date : 02/19/2019

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Directions to “ RANDY ENCISO ” Practice Location

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