Marissa Blanco

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-15-18774 Issued in CA

Practice address

13400 Riverside Dr Ste 209
Sherman Oaks, CA 91423-2545

Phone

(661) 254-7086

Fax

(818) 308-6487

NPI assigned

Nov 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1447113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1861865073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28245 AVENUE CROCKER",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913550940",
            "telephone_number": "661-254-7086",
            "fax_number": "661-254-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13400 RIVERSIDE DR STE 209",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914232545",
            "telephone_number": "661-254-7086",
            "fax_number": "818-308-6487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANCO",
        "first_name": "MARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-10",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-15-18774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.