Provider Demographics
NPI:1336747401
Name:FUENTES, TANYA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:ABU-KHALAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:11660 CHURCH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8918
Mailing Address - Country:US
Mailing Address - Phone:909-240-6848
Mailing Address - Fax:
Practice Address - Street 1:1776 AVENUE OF THE STATES
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4591
Practice Address - Country:US
Practice Address - Phone:732-730-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-63138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst