| NPI | 1659918852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK KELLY Director, Revenue Cycle Support 714-509-7861 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 106E00000X Assistant Behavior Analyst | |
| 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2019-12-06 |