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NPI Code Detail

MEDICARE: ALBA YANIRA JATHAN TEACHER ASSISTANT

MEDICARE: ALBA YANIRA JATHAN TEACHER ASSISTANT
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 TechnicianCA

General Provider Information

NPI Number : 1245879543
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALBA YANIRA JATHAN TEACHER ASSISTANT
Provider Business Mailing Address
First Line : 22340 GERMAIN ST UNIT 2
Second Line :
City : CHATSWORTH
State : CA
Zip : 91311-0385
Country : US
Telephone Number : 818-357-3166
Fax Number :
Provider Business Practice Location Address
First Line : 21600 OXNARD ST STE 1030
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-5085
Country : US
Telephone Number : 877-206-1009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2020
Last Update Date : 01/03/2020

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