Provider Demographics
NPI:1508118126
Name:FATTAL, ROBBIE EL (BCBA-D, LBA)
Entity Type:Individual
Prefix:MR
First Name:ROBBIE
Middle Name:EL
Last Name:FATTAL
Suffix:
Gender:M
Credentials:BCBA-D, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 N CHAUCER WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-3545
Mailing Address - Country:US
Mailing Address - Phone:714-366-0822
Mailing Address - Fax:
Practice Address - Street 1:1577 N CHAUCER WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-3545
Practice Address - Country:US
Practice Address - Phone:714-366-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-10300103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst