Provider Demographics
NPI:1649533753
Name:TELLO-DI LEVA, RUTH (MS, BCBA)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:TELLO-DI LEVA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1484
Mailing Address - Country:US
Mailing Address - Phone:626-320-1317
Mailing Address - Fax:626-270-4225
Practice Address - Street 1:222 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1484
Practice Address - Country:US
Practice Address - Phone:626-320-1317
Practice Address - Fax:626-270-4225
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst