Basic Information
| Provider Information | |||||||||
| NPI: | 1518455880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAYORGA QUANT | ||||||||
| FirstName: | CELINA | ||||||||
| MiddleName: | ANGELICA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18726 S WESTERN AVE STE 408 | ||||||||
| Address2: | |||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902483858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108560800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3336 BRADSHAW RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166321330 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2018 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-20-46041 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | 16-15408 | N |
No ID Information.