MEDICARE: VANESSA HARRIS BCABA

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	0-13-5432	CA

General Provider Information

NPI Number	:	1821430760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA HARRIS BCABA

Provider Business Mailing Address
First Line	:	3978 SORRENTO VALLEY BLVD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1436
Country	:	US
Telephone Number	:	858-764-2956
Fax Number	:

Provider Business Practice Location Address
First Line	:	3978 SORRENTO VALLEY BLVD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1436
Country	:	US
Telephone Number	:	858-764-2956
Fax Number	:

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

Provider Enumeration Date	:	07/19/2013
Last Update Date	:	07/19/2013

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