1730574955 NPI number — MISS RYANNE AURELEE TRIAS GARZA BCBA

Table of content: MISS RYANNE AURELEE TRIAS GARZA BCBA (NPI 1730574955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730574955 NPI number — MISS RYANNE AURELEE TRIAS GARZA BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARZA
Provider First Name:
RYANNE AURELEE
Provider Middle Name:
TRIAS
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMOMONPON
Provider Other First Name:
RYANNE
Provider Other Middle Name:
TRIAS
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1730574955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5432 W ATHENS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93722-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-907-6126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7413 N CEDAR AVE STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-930-2720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2015

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:  1-15-17956 , 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)