Provider Demographics
NPI:1033768015
Name:SANTOS, JUDITH (BCBA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:MACIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15335 FLAGSTAFF ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-3809
Mailing Address - Country:US
Mailing Address - Phone:626-216-4784
Mailing Address - Fax:
Practice Address - Street 1:1420 E COOLEY DR STE 204
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3953
Practice Address - Country:US
Practice Address - Phone:310-388-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12366127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst