MEDICARE: VICTORIA DOYLE BEHAVIOR TECHNICIAN

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1265018303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA DOYLE BEHAVIOR TECHNICIAN

Provider Business Mailing Address
First Line	:	11037 WARNER AVE # 339
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4007
Country	:	US
Telephone Number	:	800-273-4292
Fax Number	:	714-596-6274

Provider Business Practice Location Address
First Line	:	2660 NE HWY 20
Second Line	:	SUITE 610 BMB 1005
City	:	BEND
State	:	OR
Zip	:	97701-6403
Country	:	US
Telephone Number	:	800-273-4292
Fax Number	:	714-596-6274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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Directions to “ VICTORIA DOYLE BEHAVIOR TECHNICIAN” Practice Location

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