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NPI Code Detail

MEDICARE: MRS. STEPHANIE ILAGAN WALDO M.S., BCBA

MEDICARE: MRS. STEPHANIE ILAGAN WALDO M.S., 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
1103K00000XBehavior Analyst1-19-39189

General Provider Information

NPI Number : 1215434238
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE ILAGAN WALDO M.S., BCBA
Provider Business Mailing Address
First Line : DEPT LA 22763
Second Line :
City : PASADENA
State : CA
Zip : 91185-2763
Country : US
Telephone Number : 866-523-4268
Fax Number :
Provider Business Practice Location Address
First Line : 6560 LONETREE BLVD STE 100
Second Line :
City : ROCKLIN
State : CA
Zip : 95765-5891
Country : US
Telephone Number : 866-523-4268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2018
Last Update Date : 03/21/2023

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