Provider Demographics
NPI:1891247367
Name:SEVILLANOS-MYERS, DIANA (BCBA, PPS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SEVILLANOS-MYERS
Suffix:
Gender:F
Credentials:BCBA, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15311 CUDA DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-9280
Mailing Address - Country:US
Mailing Address - Phone:661-213-6084
Mailing Address - Fax:
Practice Address - Street 1:15311 CUDA DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-9280
Practice Address - Country:US
Practice Address - Phone:661-213-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-15040103K00000X
CA1600005457103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool