Provider Demographics
NPI:1689370611
Name:EXCELENCIA BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:EXCELENCIA BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:JUANA
Authorized Official - Middle Name:ABIGAHIL
Authorized Official - Last Name:MENDOZA MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:760-214-5522
Mailing Address - Street 1:29115 VALLEY CENTER RD # K215
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6560
Mailing Address - Country:US
Mailing Address - Phone:760-214-5522
Mailing Address - Fax:
Practice Address - Street 1:29115 VALLEY CENTER RD # K215
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6560
Practice Address - Country:US
Practice Address - Phone:760-214-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty