Individual
AERA ENNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
24021 ALESSANDRO BLVD STE 118, MORENO VALLEY, CA 92553-6710
(951) 357-6926
Mailing address
100 N PACIFIC COAST HWY STE 1400, EL SEGUNDO, CA 90245-5602
(949) 357-2556
(949) 357-2556
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/06/2026
Last updated
01/06/2026
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