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NPI Code Detail

MEDICARE: MRS. KRYSTLE NICOLE GRGICH M.A., BCBA

MEDICARE: MRS. KRYSTLE NICOLE GRGICH 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
1103K00000XBehavior Analyst1-17-25092CA

General Provider Information

NPI Number : 1811429814
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRYSTLE NICOLE GRGICH M.A., BCBA
Provider Business Mailing Address
First Line : 3652 MICHELSON DR
Second Line :
City : IRVINE
State : CA
Zip : 92612-1727
Country : US
Telephone Number : 949-474-1493
Fax Number :
Provider Business Practice Location Address
First Line : 3652 MICHELSON DR
Second Line :
City : IRVINE
State : CA
Zip : 92612-1727
Country : US
Telephone Number : 949-474-1493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2017
Last Update Date : 03/11/2022

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