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NPI Code Detail

MEDICARE: STEFAN AGREGADO RBT

MEDICARE: STEFAN AGREGADO RBT
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 Technician

General Provider Information

NPI Number : 1255836383
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFAN AGREGADO RBT
Provider Business Mailing Address
First Line : 1700 WINCHESTER BLVD STE 101
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1163
Country : US
Telephone Number : 844-876-5177
Fax Number : 408-625-1119
Provider Business Practice Location Address
First Line : 1700 WINCHESTER BLVD STE 101
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1163
Country : US
Telephone Number : 844-876-5177
Fax Number : 408-625-1119
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2018
Last Update Date : 03/29/2018

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Directions to “ STEFAN AGREGADO RBT” Practice Location

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