MEDICARE: FUN WITH ABA, 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124876529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUN WITH ABA, LLC

Provider Business Mailing Address
First Line	:	4464 LONE TREE WAY # 616
Second Line	:
City	:	ANTIOCH
State	:	CA
Zip	:	94531-7413
Country	:	US
Telephone Number	:	510-747-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 ABRAZAR AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4431
Country	:	US
Telephone Number	:	510-747-2850
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	NADIRAH ALDAYLAM
Credential	:	M.ED, BCBA,LBA
Telephone Number	:	510-747-2850

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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