MEDICARE: MS. RUBILENE NOGUERA 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
1	103K00000X	Behavior Analyst	1-04-1802	CA

General Provider Information

NPI Number	:	1093970386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUBILENE NOGUERA BCBA

Provider Business Mailing Address
First Line	:	PO BOX 9852
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95157-0852
Country	:	US
Telephone Number	:	415-244-7628
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 SARATOGA AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3428
Country	:	US
Telephone Number	:	408-423-8076
Fax Number	:

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	05/03/2018

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