Provider Demographics
NPI:1588186415
Name:WILBAT, MATTHEW B (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:WILBAT
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 ALVARADO RD UNIT 17
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5232
Mailing Address - Country:US
Mailing Address - Phone:858-344-8743
Mailing Address - Fax:
Practice Address - Street 1:6851 ALVARADO RD.
Practice Address - Street 2:#17
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:858-344-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-17325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst