Provider Demographics
NPI:1376059485
Name:RANGEL, RUBEN (BCBA)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:RANGEL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 PARK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-4568
Mailing Address - Country:US
Mailing Address - Phone:707-694-3180
Mailing Address - Fax:
Practice Address - Street 1:2940 PARK MEADOW DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-4568
Practice Address - Country:US
Practice Address - Phone:707-694-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1172727010103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst