Healthcare Provider Details

I. General information

NPI: 1821726407
Provider Name (Legal Business Name): POP THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5597 E VISTA DEL RIO
ANAHEIM CA
92807-3859
US

IV. Provider business mailing address

PO BOX 18987
ANAHEIM CA
92817-8987
US

V. Phone/Fax

Practice location:
  • Phone: 714-469-0425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CORAL LY
Title or Position: CO-FOUNDER
Credential: BCBA
Phone: 657-562-8102