Provider Demographics
NPI:1063009686
Name:ELAOG, ATHENA ABEGAIL BAUTISTA (BCBA)
Entity type:Individual
Prefix:
First Name:ATHENA ABEGAIL
Middle Name:BAUTISTA
Last Name:ELAOG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:
Other - Last Name:ELAOG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:3840 ROSIN CT STE 130
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3840 ROSIN CT STE 130
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1699
Practice Address - Country:US
Practice Address - Phone:916-374-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-25-78825103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst