MEDICARE: CREATING A POSITIVE ENVIRONMENT, INC.

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
1	252Y00000X	Early Intervention Provider Agency	11518111	CA

General Provider Information

NPI Number	:	1497245526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATING A POSITIVE ENVIRONMENT, INC.

Provider Business Mailing Address
First Line	:	3375 MESA RIDGE RD APT 107
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010-6730
Country	:	US
Telephone Number	:	760-916-5910
Fax Number	:	760-683-6778

Provider Business Practice Location Address
First Line	:	3375 MESA RIDGE RD APT 107
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010-6730
Country	:	US
Telephone Number	:	760-916-5910
Fax Number	:	760-683-6778

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. ANA C BASE
Credential	:	M.S., BCBA
Telephone Number	:	760-916-5910

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	01/03/2023

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