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NPI Code Detail

MEDICARE: CHARMIN ROSE GENTRY BCBA

MEDICARE: CHARMIN ROSE GENTRY 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
1106E00000XAssistant Behavior Analyst
2103K00000XBehavior Analyst1-22-62808

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10-17-7794OTHERBEHAVIOR ANALYST CERTIFICATION BOARD, INC. (BACB)
21-22-62808OTHERCABEHAVIOR ANALYST CERTIFICATION BOARD, INC. (BACB)

General Provider Information

NPI Number : 1194248773
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARMIN ROSE GENTRY BCBA
Provider Business Mailing Address
First Line : 2820 CAMINO DEL RIO S STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3822
Country : US
Telephone Number : 800-434-8923
Fax Number : 615-905-9200
Provider Business Practice Location Address
First Line : 2820 CAMINO DEL RIO S STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3822
Country : US
Telephone Number : 800-434-8923
Fax Number : 615-905-9200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2017
Last Update Date : 07/21/2023

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