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NPI Code Detail

MEDICARE: MS. KIMBERLY MICHELLE MATTATALL BCBA

MEDICARE: MS. KIMBERLY MICHELLE MATTATALL 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
1103K00000XBehavior Analyst1-14-9559CA

General Provider Information

NPI Number : 1992108393
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY MICHELLE MATTATALL BCBA
Provider Business Mailing Address
First Line : 5762 BOLSA AVE
Second Line : SUITE 101
City : HUNTINGTON BEACH
State : CA
Zip : 92649-1172
Country : US
Telephone Number : 714-292-2322
Fax Number : 714-866-4153
Provider Business Practice Location Address
First Line : 23046 AVENIDA DE LA CARLOTA STE 600
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1537
Country : US
Telephone Number : 949-543-6950
Fax Number : 888-403-6922
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2014
Last Update Date : 03/01/2019

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