MEDICARE: NAYELI CERCEDA RAMIREZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1164015962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAYELI CERCEDA RAMIREZ

Provider Business Mailing Address
First Line	:	2115 W CRESCENT AVE STE 244
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-3836
Country	:	US
Telephone Number	:	714-829-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 W LA HABRA BLVD
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-5012
Country	:	US
Telephone Number	:	562-475-7204
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	02/12/2021

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Directions to “ NAYELI CERCEDA RAMIREZ ” Practice Location

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