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NPI Code Detail

MEDICARE: LAQUACIA PENN RBT

MEDICARE: LAQUACIA PENN RBT
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 TechnicianRBT-26-509282

General Provider Information

NPI Number : 1558220780
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAQUACIA PENN RBT
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 900
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3740 FERNANDINA RD STE A
Second Line :
City : COLUMBIA
State : SC
Zip : 29210-3877
Country : US
Telephone Number : 803-335-0718
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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Directions to “ LAQUACIA PENN RBT” Practice Location

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