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NPI Code Detail

MEDICARE: ANESSA LEE TRUJILLO BCBA

MEDICARE: ANESSA LEE TRUJILLO 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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst1-20-44833CA

General Provider Information

NPI Number : 1396203469
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANESSA LEE TRUJILLO BCBA
Provider Business Mailing Address
First Line : 8824 19TH ST APT 48
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91701-4600
Country : US
Telephone Number : 626-221-9052
Fax Number :
Provider Business Practice Location Address
First Line : 2601 MARBER AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90815-1137
Country : US
Telephone Number : 562-377-1027
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2019
Last Update Date : 09/14/2023

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