Basic Information
| Provider Information | |||||||||
| NPI: | 1538761523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIJERINA | ||||||||
| FirstName: | ERICKA | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 W RENWICK RD | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917405567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265007072 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 S LAKE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911013009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264327270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2020 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 103K00000X | 1-21-52610 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.