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NPI Code Detail

MEDICARE: MRS. TARA GENE MIJARES MA,BCBA,MS, CCC-SLP

MEDICARE: MRS. TARA GENE MIJARES MA,BCBA,MS, CCC-SLP
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 Analyst1-12-10151
2235Z00000XSpeech-Language Pathologist36341CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-12-10151OTHERBCBA BOARD CERTIFICATION
236341OTHERCACA STATE SLP LICENSURE

General Provider Information

NPI Number : 1871868513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TARA GENE MIJARES MA,BCBA,MS, CCC-SLP
Provider Business Mailing Address
First Line : 28245 AVENUE CROCKER
Second Line :
City : VALENCIA
State : CA
Zip : 91355-0940
Country : US
Telephone Number : 661-425-4561
Fax Number :
Provider Business Practice Location Address
First Line : 28245 AVENUE CROCKER STE 220
Second Line :
City : VALENCIA
State : CA
Zip : 91355-1201
Country : US
Telephone Number : 661-425-4561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2012
Last Update Date : 12/07/2023

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