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NPI Code Detail

MEDICARE: TUSTIN ABA SERVICES FOR KIDS LLC

MEDICARE: TUSTIN ABA SERVICES FOR KIDS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist
2106E00000XAssistant Behavior Analyst
3225X00000XOccupational Therapist
42355S0801XSpeech-Language Assistant
5224Z00000XOccupational Therapy Assistant
6106S00000XBehavior Technician
7103K00000XBehavior Analyst

General Provider Information

NPI Number : 1316353709
Entity Type Code : Organization
Provider Name (Legal Business Name) : TUSTIN ABA SERVICES FOR KIDS LLC
Provider Business Mailing Address
First Line : 2201 E 4TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3804
Country : US
Telephone Number : 714-683-5876
Fax Number : 888-420-6257
Provider Business Practice Location Address
First Line : 2201 E 4TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3804
Country : US
Telephone Number : 714-683-5876
Fax Number : 888-420-6257
Authorized Official
Title or Position : ADMINISTRATOR
Name : DIANA KENNEY FUNK
Credential :
Telephone Number : 949-422-3609
Provider Enumeration Date : 07/07/2014
Last Update Date : 10/20/2025

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Directions to “TUSTIN ABA SERVICES FOR KIDS LLC ” Practice Location

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