# MEBE MARYLAND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417554031
- **Authorized official:** ESTEBAN GONZALEZ (CONTRACTS AND CREDENTIALING SPEC.)
- **Authorized official phone:** (619) 323-0832

## Contact information

- **Practice address:** 11140 ROCKVILLE PIKE \# 565, ROCKVILLE, MD 20852-3106
- **Practice address phone:** (619) 795-9925
- **Mailing address:** 8885 RIO SAN DIEGO DR STE 340, SAN DIEGO, CA 92108-1669
- **Mailing address phone:** (619) 795-9925

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 10/06/2020
- **Last updated:** 02/10/2021