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NPI Code Detail

MEDICARE: MARINE AVAGYAN BCBA

MEDICARE: MARINE AVAGYAN 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
1106S00000XBehavior Technician16-15400CA
2103K00000XBehavior Analyst1-24-71351CA

General Provider Information

NPI Number : 1245731462
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINE AVAGYAN BCBA
Provider Business Mailing Address
First Line : 150 GLEN COVE MARINA RD E STE 102
Second Line :
City : VALLEJO
State : CA
Zip : 94591-7237
Country : US
Telephone Number : 707-553-1784
Fax Number :
Provider Business Practice Location Address
First Line : 150 GLEN COVE MARINA RD E STE 102
Second Line :
City : VALLEJO
State : CA
Zip : 94591-7237
Country : US
Telephone Number : 707-553-1784
Fax Number : 510-373-1738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2018
Last Update Date : 03/08/2024

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Directions to “ MARINE AVAGYAN BCBA” Practice Location

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