Provider Demographics
NPI:1083925481
Name:URENA, EVA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:URENA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9037 NATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3128
Mailing Address - Country:US
Mailing Address - Phone:310-866-8754
Mailing Address - Fax:
Practice Address - Street 1:9037 NATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3128
Practice Address - Country:US
Practice Address - Phone:310-866-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-06-2771103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-06-2771OtherBEHAVIOR ANALYST CERTIFICATION BOARD CERTIFICANT