MEDICARE: LUZ M MANCIA 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	1-21-51624	CA

General Provider Information

NPI Number	:	1881267177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ M MANCIA BCBA

Provider Business Mailing Address
First Line	:	5949 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1006
Country	:	US
Telephone Number	:	323-850-7177
Fax Number	:	323-850-7747

Provider Business Practice Location Address
First Line	:	5949 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1006
Country	:	US
Telephone Number	:	323-850-7177
Fax Number	:	323-850-7747

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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