Provider Demographics
NPI:1619340288
Name:TAYLOR, VICTORIA BARRETT (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BARRETT
Last Name:TAYLOR
Suffix:
Gender:F
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 1:12443 LEWIS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4650
Mailing Address - Country:US
Mailing Address - Phone:714-748-4440
Mailing Address - Fax:
Practice Address - Street 1:17853 SANTIAGO BLVD
Practice Address - Street 2:#107-329
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-4113
Practice Address - Country:US
Practice Address - Phone:714-748-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19818103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst