Provider Demographics
NPI:1669939104
Name:LANDAVERDE, NANCY XIOMARA (BCBA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:XIOMARA
Last Name:LANDAVERDE
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 1:900 CORPORATE CENTER DR STE 350
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7620
Mailing Address - Country:US
Mailing Address - Phone:626-759-0252
Mailing Address - Fax:
Practice Address - Street 1:900 CORPORATE CENTER DR STE 350
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7620
Practice Address - Country:US
Practice Address - Phone:626-759-0252
Practice Address - Fax:323-526-4096
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-33813103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst