MEDICARE: CHALENE ABRENA NAVARRO 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	CERT-1-17-26093	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-17-26093	OTHER	CA	BEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number	:	1457872871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHALENE ABRENA NAVARRO BCBA

Provider Business Mailing Address
First Line	:	7120 N FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-1250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 N FIGUEROA ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-1250
Country	:	US
Telephone Number	:	818-687-2351
Fax Number	:

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

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	07/06/2017

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