Provider Demographics
NPI:1982083218
Name:MONCAYO, SUAN MELISSA ILAGAN (MS, BCBA)
Entity type:Individual
Prefix:
First Name:SUAN MELISSA
Middle Name:ILAGAN
Last Name:MONCAYO
Suffix:
Gender:F
Credentials:MS, BCBA
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Mailing Address - Street 1:3500 W MANCHESTER BLVD UNIT 63
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-4063
Mailing Address - Country:US
Mailing Address - Phone:310-561-5745
Mailing Address - Fax:
Practice Address - Street 1:145 S. FAIRFAX AVE.
Practice Address - Street 2:FLOOR 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2166
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1-14-17807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst