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NPI Code Detail

MEDICARE: DEYSSY ESQUIVEL RADZIENDA BCBA

MEDICARE: DEYSSY ESQUIVEL RADZIENDA 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1326505215
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEYSSY ESQUIVEL RADZIENDA BCBA
Provider Business Mailing Address
First Line : 299 W HILLCREST DR STE 110
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-7824
Country : US
Telephone Number : 805-379-1401
Fax Number : 805-379-1491
Provider Business Practice Location Address
First Line : 8025 N POINT BLVD STE 100
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-3291
Country : US
Telephone Number : 704-780-4271
Fax Number : 805-379-1491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2019
Last Update Date : 06/10/2024

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