MEDICARE: MRS. MAGGIE LEUNG MA M.A., 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	1-10-7416	CA

General Provider Information

NPI Number	:	1710218755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAGGIE LEUNG MA M.A., BCBA

Provider Business Mailing Address
First Line	:	5694 MISSION CENTER RD
Second Line	:	SUITE 602 PMB 341
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4355
Country	:	US
Telephone Number	:	510-213-8583
Fax Number	:	619-220-0215

Provider Business Practice Location Address
First Line	:	5694 MISSION CENTER RD
Second Line	:	SUITE 602 PMB 341
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4355
Country	:	US
Telephone Number	:	510-213-8583
Fax Number	:	619-220-0215

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	03/07/2012

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