Provider Demographics
NPI:1194026948
Name:ELENZ-MARTIN, KAMERON (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:
Last Name:ELENZ-MARTIN
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 1:1333 S MAYFLOWER AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5239
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:888-588-2752
Practice Address - Street 1:4025 CAMINO DEL RIO S STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4100
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:888-588-2752
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7629103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst