Provider Demographics
NPI:1962973446
Name:TAYLOR, BERTHA (BCBA)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:TAYLOR
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 1:12865 POWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6054
Mailing Address - Country:US
Mailing Address - Phone:210-393-5743
Mailing Address - Fax:
Practice Address - Street 1:5945 PACIFIC CENTER BLVD STE 510
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-6305
Practice Address - Country:US
Practice Address - Phone:210-393-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty