Provider Demographics
NPI:1932688330
Name:MORON MIRANDA, ANALIS MARIA (BCBA)
Entity Type:Individual
Prefix:
First Name:ANALIS
Middle Name:MARIA
Last Name:MORON MIRANDA
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 1:9224 BROOKSHIRE AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2951
Mailing Address - Country:US
Mailing Address - Phone:562-746-0146
Mailing Address - Fax:
Practice Address - Street 1:11022 SANTA MONICA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7566
Practice Address - Country:US
Practice Address - Phone:626-755-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30502103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst