Provider Demographics
NPI:1134777089
Name:VIGIL-TOLDEO, JESSICA ESMERALDA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ESMERALDA
Last Name:VIGIL-TOLDEO
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 1:12219 WALL ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2340
Mailing Address - Country:US
Mailing Address - Phone:310-428-7679
Mailing Address - Fax:
Practice Address - Street 1:19750 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1119
Practice Address - Country:US
Practice Address - Phone:714-332-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-35910103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-19-35910OtherBCAB