JUSTIN ELIZALDE (NPI# 1306360805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306360805 |
| Entity Type | Individual |
| Full Name | JUSTIN ELIZALDE |
| Practice Address |
12465 Lewis St Ste 102 Garden Grove CA 92840-4658 |
| Mailing Address |
16782 Von Karman Ave Ste 11 Irvine CA 92606-2417 |
| Practice Telephone | 9498332237 |
| Mailing Telephone | 8552237123 |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2019-12-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103K00000X | Behavioral Analyst | 1-19-37279 | CA | Behavioral Health & Social Service Providers |
| N | 106S00000X | Behavior Technician | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 16782 Von Karman Ave Ste 11, Irvine, CA 92606 | 8552237123 | |
| 41521 W 11 Mile Rd, Novi, MI 483751803 | (248) 299-0030 | 8006514201 |
| Street Address |
12465 LEWIS ST STE 102 |
| City | GARDEN GROVE |
| State | CA |
| Zip Code | 92840-4658 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568594851 | Mario Enrique Ruiz Jr. | Rehabilitation Practitioner | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2007-03-12 |
| 1316546237 | Teresa Dutra | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-10-21 |
| 1740888460 | Mayra Flores | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-10-14 |
| 1184221681 | Henry Gutierrez | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-10-07 |
| 1215551718 | Ingrid Vazquez-camacho | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-06-01 |
| 1841814340 | Breanna Ordaz | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-06-01 |
| 1609490176 | Victor Aguilar | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-06-01 |
| 1417571811 | Cortney Goodwin | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-06-01 |
| 1255952685 | Hailey Evans-williams | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-04-27 |
| 1760002117 | Polette Luna | Behavior Technician | 12465 Lewis St Ste 102, Garden Grove, CA 92840-4658 | 2020-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588283808 | Kimberly Gaeta | Behavioral Analyst | 123935 Lewis Street, Ste 202, Garden Grove, CA 92840 | 2020-04-16 |
| 1396397170 | Rosa Cortez | Behavior Technician | 12443 Lewis Street, #201, Garden Grove, CA 92840 | 2019-07-12 |
| 1376005934 | Sekboppa Sor | Nurse Practitioner | An Lanh Free Clinic, 10861 Acacia Pkwy., Garden Grove, CA 92840 | 2019-04-03 |
| 1346730116 | Vinh Le Tran | Pharmacist | 12666 Brookhurst St. Suite 110, Garden Grove, CA 92840 | 2018-05-16 |
| 1841715232 | Scott R. Blair | Physician Assistant | 12828 Harbor Blvd Ste 200, Garden Grove, CA 92840 | 2017-08-07 |
| 1881049492 | Carmen Keally | Dietitian, Registered | 12602 9th St, Garden Grove, CA 92840 | 2016-05-02 |
| 1548688732 | House Call Medical Associates, Inc. | Internal Medicine | 12865 Main St Ste 105, Garden Grove, CA 92840 | 2014-04-03 |
| 1851733059 | Carly Ann Wade | Marriage & Family Therapist | 12755 Brookhurst St. Ste 116, Garden Grove, CA 92840 | 2013-07-29 |
| 1003159864 | Priyal Shah Ohri | Dentist | 10602 Chapman Ave, Suite 200, Garden Grove, CA 92840 | 2013-03-30 |
| 1770853244 | Joseph Pham | Pharmacist | 12001 Euclid St., Garden Grove, CA 92840 | 2011-12-30 |
| Find all providers in zip 92840 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588283808 | Kimberly Gaeta | Behavioral Analyst | 123935 Lewis Street, Ste 202, Garden Grove, CA 92840 | 2020-04-16 |
| 1962064998 | The Autism Collaborative Group | Behavioral Analyst | 12792 Valley View St Ste 201, Garden Grove, CA 92845-2510 | 2019-06-29 |
| 1275093361 | Gina Westmoreland | Behavioral Analyst | 12630 Brookhurst St Ste D, Garden Grove, CA 92840-4800 | 2019-03-23 |
| 1356825624 | Pheakdey Soch | Behavioral Analyst | 12322 Manley St, Garden Grove, CA 92845-1940 | 2018-09-21 |
| 1154838712 | Dana Dang | Behavioral Analyst | 12395 Lewis St Ste 202, Garden Grove, CA 92840-4694 | 2018-01-04 |
| 1467969436 | Amy Cardona | Behavioral Analyst | 8102 Bestel Ave, Garden Grove, CA 92844-1712 | 2017-12-29 |
| 1720458920 | Alfredo Montiel | Behavioral Analyst | 12395 Lewis St, Suite 202, Garden Grove, CA 92840-6600 | 2015-09-30 |
| 1821336843 | Nahal Kashani Hosseinzadeh | Behavioral Analyst | 12399 Lewis St Ste 202, Garden Grove, CA 92840-4697 | 2013-01-25 |
| 1821332461 | Khang Nguyen | Behavioral Analyst | 12682 Pleasant Pl, Garden Grove, CA 92841-4939 | 2012-11-20 |
| 1306101456 | Steve John Perez | Behavioral Analyst | 13100 Gilbert St, Unit 39, Garden Grove, CA 92844-2156 | 2012-07-05 |
| Find all providers in GARDEN GROVE | ||||
| City | GARDEN GROVE |
| Zip Code | 92840 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.