Provider Demographics
NPI:1447740469
Name:IGUALDO, LEO P JR (BCBA)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:P
Last Name:IGUALDO
Suffix:JR
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 1:25190 HANCOCK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5984
Mailing Address - Country:US
Mailing Address - Phone:951-200-5532
Mailing Address - Fax:951-271-9542
Practice Address - Street 1:25190 HANCOCK AVE STE C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5984
Practice Address - Country:US
Practice Address - Phone:951-200-5532
Practice Address - Fax:951-271-9542
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst