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NPI Code Detail

MEDICARE: GERARDO PRECIADO

MEDICARE: GERARDO PRECIADO
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
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1JQC96822141DOTHERCALA HEALTH CARE PLAN

General Provider Information

NPI Number : 1881152569
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERARDO PRECIADO
Provider Business Mailing Address
First Line : 7226 SEPULVEDA BLVD
Second Line :
City : VAN NUYS
State : CA
Zip : 91405-2003
Country : US
Telephone Number : 818-235-1414
Fax Number :
Provider Business Practice Location Address
First Line : 1216 W AVENUE J STE 100
Second Line :
City : LANCASTER
State : CA
Zip : 93534-2944
Country : US
Telephone Number : 661-215-2749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2019
Last Update Date : 03/12/2019

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Directions to “ GERARDO PRECIADO ” Practice Location

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