Provider Demographics
NPI:1013271139
Name:SILVEIRA-ZALDIVAR, TRACEY LYNNE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYNNE
Last Name:SILVEIRA-ZALDIVAR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYNNE
Other - Last Name:ZALDIVAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:22686 CHERYL WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5515
Mailing Address - Country:US
Mailing Address - Phone:714-402-2116
Mailing Address - Fax:
Practice Address - Street 1:770 S BREA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5312
Practice Address - Country:US
Practice Address - Phone:714-529-9274
Practice Address - Fax:714-523-1272
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4885103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst