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NPI Code Detail

MEDICARE: MARYLOU ROSE BARAYUGA BCBA

MEDICARE: MARYLOU ROSE BARAYUGA 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 Analyst11833702CA

General Provider Information

NPI Number : 1457917288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYLOU ROSE BARAYUGA BCBA
Provider Business Mailing Address
First Line : 100 TERMINO AVE APT 2
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-2833
Country : US
Telephone Number : 805-512-6459
Fax Number :
Provider Business Practice Location Address
First Line : 444 W OCEAN BLVD STE 800
Second Line :
City : LONG BEACH
State : CA
Zip : 90802-4529
Country : US
Telephone Number : 888-286-8715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2019
Last Update Date : 05/16/2019

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