Provider Demographics
NPI:1629672340
Name:ENVERGA, ANN (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ENVERGA
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 1:555 PARKCENTER DR STE 221
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3521
Mailing Address - Country:US
Mailing Address - Phone:714-310-4377
Mailing Address - Fax:
Practice Address - Street 1:15328 JANINE DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-1312
Practice Address - Country:US
Practice Address - Phone:714-310-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-435431103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst