Provider Demographics
NPI:1285396572
Name:OBREGON, DANIELLE ROCHELLE (MS, BCBA)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:ROCHELLE
Last Name:OBREGON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:ROCHELLE
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:533 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5865
Mailing Address - Country:US
Mailing Address - Phone:909-436-8120
Mailing Address - Fax:
Practice Address - Street 1:533 S CENTER ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5865
Practice Address - Country:US
Practice Address - Phone:909-436-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-53965103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27-1252817Medicaid