Provider Demographics
NPI:1417406471
Name:ENRIQUEZ, TASHA (BCBA)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:FLACZINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18797 MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9620
Mailing Address - Country:US
Mailing Address - Phone:951-515-6372
Mailing Address - Fax:
Practice Address - Street 1:9201 OAKDALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6546
Practice Address - Country:US
Practice Address - Phone:909-284-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-23189103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst