MEDICARE: SUAN MELISSA ILAGAN MONCAYO 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	1-14-17807	CA

General Provider Information

NPI Number	:	1982083218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUAN MELISSA ILAGAN MONCAYO M.S., BCBA

Provider Business Mailing Address
First Line	:	3500 W MANCHESTER BLVD UNIT 63
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90305-4063
Country	:	US
Telephone Number	:	310-561-5745
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 S. FAIRFAX AVE.
Second Line	:	FLOOR 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2166
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	11/12/2025

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