Basic Information
| Provider Information | |||||||||
| NPI: | 1366976003 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROOF POSITIVE ABA THERAPIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 N BRAND BLVD STE 1000 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912033924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182416780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 BAKER ST | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926264138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499106767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2017 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | GUERRA | ||||||||
| AuthorizedOfficialFirstName: | BRIANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 8182416780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-25523 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.