Healthcare Provider Details

I. General information

NPI: 1083057335
Provider Name (Legal Business Name): ABA BEARS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 19TH ST UNIT 398
ALTA LOMA CA
91701-4608
US

IV. Provider business mailing address

8780 19TH ST UNIT 398
ALTA LOMA CA
91701-4608
US

V. Phone/Fax

Practice location:
  • Phone: 888-618-2327
  • Fax: 888-918-2327
Mailing address:
  • Phone: 888-618-2327
  • Fax: 888-918-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES SLOAN
Title or Position: DIRECTOR
Credential:
Phone: 888-618-2327