MEDICARE: CHRISTIAN JOSE RAMOS ESTRADA M.S, 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	12149597	CA

General Provider Information

NPI Number	:	1639753544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN JOSE RAMOS ESTRADA M.S, BCBA

Provider Business Mailing Address
First Line	:	6245 CAHUENGA BLVD APT 5
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3900
Country	:	US
Telephone Number	:	818-326-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1093 BROXTON AVE STE 240
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2831
Country	:	US
Telephone Number	:	310-871-6800
Fax Number	:

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

Provider Enumeration Date	:	05/06/2021
Last Update Date	:	08/12/2022

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