Provider Demographics
NPI:1568958387
Name:MENCHACA, GILBERT JOSEPH (BCBA)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:JOSEPH
Last Name:MENCHACA
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 1:4325 FRANKLIN AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2862
Mailing Address - Country:US
Mailing Address - Phone:323-379-8400
Mailing Address - Fax:
Practice Address - Street 1:4325 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2820
Practice Address - Country:US
Practice Address - Phone:323-379-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30959103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst