Provider Demographics
NPI:1285487710
Name:GARDUNO, RICHARD (MA, BCBA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:GARDUNO
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3165
Mailing Address - Country:US
Mailing Address - Phone:310-591-7298
Mailing Address - Fax:
Practice Address - Street 1:835 W CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3702
Practice Address - Country:US
Practice Address - Phone:626-223-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-24-72191103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst