Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ebony Andrea Custodio

Individual provider Behavior Technician · NPI 1679398291

Ebony Andrea Custodio is a Behavior Technician in San Diego, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2024

Practice location Address checks out

3655 Ruffin Rd Ste 100
San Diego, CA 92123-1847
Phone: (951) 813-4034
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Technician (primary) Taxonomy 106S00000X · Licence 106S00000X (CA)

Record details

NPI number1679398291
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 19, 2024
Last updated in NPPESNovember 21, 2024
Certification dateNovember 21, 2024

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