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NPI Code Detail

MEDICARE: KARLA SAMANTHA WADE

MEDICARE: KARLA SAMANTHA WADE
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 AnalystCA

General Provider Information

NPI Number : 1245831775
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARLA SAMANTHA WADE
Provider Business Mailing Address
First Line : 2428 EASTRIDGE LOOP
Second Line :
City : CHULA VISTA
State : CA
Zip : 91915-1114
Country : US
Telephone Number : 619-571-8451
Fax Number :
Provider Business Practice Location Address
First Line : 7090 MIRATECH DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3109
Country : US
Telephone Number : 619-571-8451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2020
Last Update Date : 11/02/2020

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Directions to “ KARLA SAMANTHA WADE ” Practice Location

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