Provider Demographics
NPI:1992313423
Name:GREGORY, VAILALA FELICIA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:VAILALA
Middle Name:FELICIA
Last Name:GREGORY
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 1:2721 RIDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4857
Mailing Address - Country:US
Mailing Address - Phone:619-900-8112
Mailing Address - Fax:
Practice Address - Street 1:2721 RIDGE VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4857
Practice Address - Country:US
Practice Address - Phone:619-900-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-37765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst