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NPI Code Detail

MEDICARE: ELEANOR PANNOR RBT

MEDICARE: ELEANOR PANNOR 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 Technician

General Provider Information

NPI Number : 1700681996
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELEANOR PANNOR RBT
Provider Business Mailing Address
First Line : 2704 4TH ST APT 4
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-4227
Country : US
Telephone Number : 310-995-3921
Fax Number :
Provider Business Practice Location Address
First Line : 613 OCEAN PARK BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3713
Country : US
Telephone Number : 206-841-6561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2025
Last Update Date : 02/13/2025

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Directions to “ ELEANOR PANNOR RBT” Practice Location

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