Provider Demographics
NPI:1821604703
Name:CACHOLA, MARYROSE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARYROSE
Middle Name:
Last Name:CACHOLA
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 1:31200 LANDAU BLVD APT 2810
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5146
Mailing Address - Country:US
Mailing Address - Phone:760-413-8611
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:31200 LANDAU BLVD APT 2810
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5146
Practice Address - Country:US
Practice Address - Phone:760-413-8611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12040644103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst