MEDICARE: MONICA AVILA 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
1	103K00000X	Behavior Analyst	1-14-15395	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-14-15395	OTHER	CA	BCBA

General Provider Information

NPI Number	:	1356768857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA AVILA BCBA

Provider Business Mailing Address
First Line	:	6400 TUPELO DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-1741
Country	:	US
Telephone Number	:	916-729-3098
Fax Number	:	916-729-3006

Provider Business Practice Location Address
First Line	:	6400 TUPELO DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-1741
Country	:	US
Telephone Number	:	916-729-3098
Fax Number	:	916-729-3006

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	03/21/2014

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Directions to “ MONICA AVILA BCBA” Practice Location

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