MEDICARE: ELAINE RAMOS 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	1-16-24557	CA

General Provider Information

NPI Number	:	1871034975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE RAMOS BCBA

Provider Business Mailing Address
First Line	:	505 N BRAND BLVD STE 1000
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-3924
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	25115 AVENUE STANFORD
Second Line	:	100
City	:	VALENCIA
State	:	CA
Zip	:	91355-1290
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

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

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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