MEDICARE: MARY WEBB

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	1-12-12456	CA

General Provider Information

NPI Number	:	1821342460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WEBB

Provider Business Mailing Address
First Line	:	505 N BRAND BLVD
Second Line	:	#1000
City	:	GLENDALE
State	:	CA
Zip	:	91203-1906
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	18350 MOUNT LANGLEY ST
Second Line	:	#105
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6900
Country	:	US
Telephone Number	:	714-965-2324
Fax Number	:	714-965-2684

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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Directions to “ MARY WEBB ” Practice Location

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