Basic Information
| Provider Information | |||||||||
| NPI: | 1548580616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKOV | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5838 EDISON PL | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920085520 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5838 EDISON PL | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920085520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604380078 | ||||||||
| FaxNumber: | 7604385078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 06/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BEHAVIOR ANALYST | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.