Provider Demographics
NPI:1194221267
Name:DANG, MARYANN (MED BCBA)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:DANG
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 SUGAR PINE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1656
Mailing Address - Country:US
Mailing Address - Phone:714-747-4929
Mailing Address - Fax:
Practice Address - Street 1:764 SUGAR PINE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1656
Practice Address - Country:US
Practice Address - Phone:714-747-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-27006103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst