Provider Demographics
NPI:1275189649
Name:BAUTISTA, KRIZIA NICOLE ESGUERRA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KRIZIA NICOLE
Middle Name:ESGUERRA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 LYNNHAVEN PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1497
Mailing Address - Country:US
Mailing Address - Phone:757-932-9057
Mailing Address - Fax:757-743-9004
Practice Address - Street 1:629 PHOENIX DRIVE
Practice Address - Street 2:STE. 115
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-932-9057
Practice Address - Fax:757-743-9004
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003305103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician