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NPI Code Detail

MEDICARE: ATHENA ABEGAIL BAUTISTA ELAOG BCBA

MEDICARE: ATHENA ABEGAIL BAUTISTA ELAOG BCBA
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
1103K00000XBehavior Analyst1-25-78825CA
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1063009686
Entity Type Code : Individual
Provider Name (Legal Business Name) : ATHENA ABEGAIL BAUTISTA ELAOG BCBA
Provider Business Mailing Address
First Line : 3840 ROSIN CT STE 130
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1699
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3840 ROSIN CT STE 130
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1699
Country : US
Telephone Number : 916-374-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2020
Last Update Date : 01/27/2025

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Directions to “ ATHENA ABEGAIL BAUTISTA ELAOG BCBA” Practice Location

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