MEDICARE: DAHLIA COENEN BCABA, MA

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	103K00000X	Behavior Analyst	0-13-5746	CA
2	106E00000X	Assistant Behavior Analyst	0-13-5746	OR

General Provider Information

NPI Number	:	1063835858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAHLIA COENEN BCABA, MA

Provider Business Mailing Address
First Line	:	1901 CARNEGIE AVE STE 1C
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5504
Country	:	US
Telephone Number	:	800-273-4292
Fax Number	:	949-253-4627

Provider Business Practice Location Address
First Line	:	1901 CARNEGIE AVE STE 1C
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5504
Country	:	US
Telephone Number	:	800-273-4292
Fax Number	:	949-253-4627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	03/17/2018

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Directions to “ DAHLIA COENEN BCABA, MA” Practice Location

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