MEDICARE: PARADISE LEUTA 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
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1770120206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARADISE LEUTA BCBA

Provider Business Mailing Address
First Line	:	2080 N TUSTIN AVE STE B
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-7875
Country	:	US
Telephone Number	:	855-581-0100
Fax Number	:	949-709-0311

Provider Business Practice Location Address
First Line	:	2338 W ROYAL PALM RD STE J
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9339
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	01/16/2026

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Directions to “ PARADISE LEUTA BCBA” Practice Location

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