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NPI Code Detail

MEDICARE: KRISTAN KEVIN SAN JUAN BCBA

MEDICARE: KRISTAN KEVIN SAN JUAN 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 AnalystLBA002064GA

General Provider Information

NPI Number : 1649744038
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTAN KEVIN SAN JUAN BCBA
Provider Business Mailing Address
First Line : 200 TECHNOLOGY CT SE STE E
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5203
Country : US
Telephone Number : 770-277-6293
Fax Number : 770-288-0446
Provider Business Practice Location Address
First Line : 200 TECHNOLOGY CT SE STE E
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5203
Country : US
Telephone Number : 770-277-6293
Fax Number : 770-288-0446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2019
Last Update Date : 03/10/2026

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