Provider Demographics
NPI:1194199034
Name:URBIETA, MAURA (BCBA # 11728998)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:
Last Name:URBIETA
Suffix:
Gender:F
Credentials:BCBA # 11728998
Other - Prefix:MRS
Other - First Name:MAURA
Other - Middle Name:
Other - Last Name:MORENO DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5444 W DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-7155
Mailing Address - Country:US
Mailing Address - Phone:559-559-3626
Mailing Address - Fax:
Practice Address - Street 1:1320 E SHAW AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7905
Practice Address - Country:US
Practice Address - Phone:559-754-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-14-6342103K00000X
CA11728998103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst