Provider Demographics
NPI:1598307142
Name:ARMENTA GOMEZ, LUIS RICARDO (BCBA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RICARDO
Last Name:ARMENTA GOMEZ
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 1:110 RYAN INDUSTRIAL CT STE 3&4
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1592
Mailing Address - Country:US
Mailing Address - Phone:833-758-7222
Mailing Address - Fax:
Practice Address - Street 1:500 ALFRED NOBEL DR STE 275A
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1840
Practice Address - Country:US
Practice Address - Phone:510-230-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-21-167544106S00000X
CA1-23-65137103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician