| NPI | 1487929808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE ELISABETH BRUINSMA CEO 949-474-1493 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 251S00000X (Licence: CA 1-08-4278) | |
| 252Y00000X Early Intervention Provider Agency | |
| 261Q00000X Clinic/Center | |
| 261QA3000X Clinic/Center, Augmentative Communication | |
| 261QH0700X Clinic/Center, Hearing and Speech | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2023-07-27 |