Provider Demographics
NPI:1073143830
Name:ELIZONDO, YASMINE (BCBA)
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 W ORANGEWOOD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5056
Mailing Address - Country:US
Mailing Address - Phone:714-696-2862
Mailing Address - Fax:714-242-9308
Practice Address - Street 1:1820 W ORANGEWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5056
Practice Address - Country:US
Practice Address - Phone:714-696-2862
Practice Address - Fax:714-242-9308
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-39866103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst