MEDICARE: EVA RINCON 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	1-15-18136	CA

General Provider Information

NPI Number	:	1912384132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA RINCON BCBA

Provider Business Mailing Address
First Line	:	1234 W CHESTNUT AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4536
Country	:	US
Telephone Number	:	714-360-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 W CHESTNUT AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-4536
Country	:	US
Telephone Number	:	714-360-3347
Fax Number	:

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

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	04/27/2015

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