MEDICARE: ROGUE ABA CALIFORNIA LLC

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
1	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1043050248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGUE ABA CALIFORNIA LLC

Provider Business Mailing Address
First Line	:	8910 UNIVERSITY CENTER LN STE 204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1023
Country	:	US
Telephone Number	:	603-692-8173
Fax Number	:

Provider Business Practice Location Address
First Line	:	8910 UNIVERSITY CENTER LN STE 204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1023
Country	:	US
Telephone Number	:	603-692-8173
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CF TRUE
Credential	:
Telephone Number	:	603-692-8173

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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Directions to “ROGUE ABA CALIFORNIA LLC ” Practice Location

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