MEDICARE: MICHAELA EDMON KALANZI

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

General Provider Information

NPI Number	:	1598491334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA EDMON KALANZI

Provider Business Mailing Address
First Line	:	27810 PLUTO ST
Second Line	:
City	:	HIGHLAND
State	:	CA
Zip	:	92346-6516
Country	:	US
Telephone Number	:	909-283-9549
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 E GARRY AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5809
Country	:	US
Telephone Number	:	949-922-5988
Fax Number	:

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

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	07/25/2022

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