Wolfpack ABA, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

WOLFPACK ABA, LLC

Practice address

25875 Lake Shore LN
Moreno Valley, CA 92551-1651

Phone

(714) 552-8972

NPI assigned

Dec 15, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Peter Degravio, BCBA

Title

Owner

Phone

(714) 253-2682

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639526400000",
    "number": "1588323729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25875 LAKE SHORE LN",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511651",
            "telephone_number": "714-552-8972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25875 LAKE SHORE LN",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925511651",
            "telephone_number": "714-552-8972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLFPACK ABA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-15",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "DEGRAVIO",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-253-2682",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amir Wissa
• Sarath C Witana, M.D.
• Robert Ray Witty, PA-C
• Gunnar Wolfe, MD
• Raquel Wolfe, MD
• Hayley Womack
• Jonathan Patam Won
• Clinton King Wong, O.D.
• Cristine Wong
• Howard Wong, RPH

• Behavior Analyst in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.