1548656069 NPI number — LEA LORA M.A., BCBA

Table of content: LEA LORA M.A., BCBA (NPI 1548656069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548656069 NPI number — LEA LORA M.A., BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORA
Provider First Name:
LEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548656069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 N BRAND BLVD
Provider Second Line Business Mailing Address:
#1000
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203-1906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-241-6780
Provider Business Mailing Address Fax Number:
818-241-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 GLENVIA ST
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91206-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-295-3276
Provider Business Practice Location Address Fax Number:
818-241-6853
Provider Enumeration Date:
04/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-14-16347 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-14-16347 . This is a "BCBA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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