Provider Demographics
NPI:1891114534
Name:POWERS, MANUELA O (BCBA)
Entity Type:Individual
Prefix:
First Name:MANUELA
Middle Name:O
Last Name:POWERS
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 1:18002 IRVINE BLVD STE 202C
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3322
Mailing Address - Country:US
Mailing Address - Phone:657-223-3986
Mailing Address - Fax:714-242-1646
Practice Address - Street 1:18002 IRVINE BLVD STE 202C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3322
Practice Address - Country:US
Practice Address - Phone:949-231-7979
Practice Address - Fax:714-242-1646
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-5779103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst