MEDICARE: ROBERT ADAM HAUPT M.S., 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	1073540	CA

General Provider Information

NPI Number	:	1871876094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ADAM HAUPT M.S., BCBA

Provider Business Mailing Address
First Line	:	6059 BRISTOL PKWY STE 100
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6673
Country	:	US
Telephone Number	:	310-641-1100
Fax Number	:	310-641-1174

Provider Business Practice Location Address
First Line	:	6059 BRISTOL PKWY STE 100
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6673
Country	:	US
Telephone Number	:	310-641-1100
Fax Number	:	310-641-1174

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

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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