MEDICARE: GABRIELA PEINADO

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	106E00000X	Assistant Behavior Analyst	0-15-6463	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	952162129	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1740715663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA PEINADO

Provider Business Mailing Address
First Line	:	8669 HOLDER ST
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620
Country	:	US
Telephone Number	:	714-821-3620
Fax Number	:	714-821-5683

Provider Business Practice Location Address
First Line	:	8669 HOLDER ST
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90620
Country	:	US
Telephone Number	:	714-821-3620
Fax Number	:	714-821-5683

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

Provider Enumeration Date	:	04/28/2017
Last Update Date	:	04/28/2017

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Directions to “ GABRIELA PEINADO ” Practice Location

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