Provider Demographics
NPI:1689070898
Name:GARRIDO-MANUPELLA, ANGELA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GARRIDO-MANUPELLA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3301
Mailing Address - Country:US
Mailing Address - Phone:408-427-1103
Mailing Address - Fax:
Practice Address - Street 1:474 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3301
Practice Address - Country:US
Practice Address - Phone:408-427-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4231103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst