Healthcare Provider Details

I. General information

NPI: 1659122794
Provider Name (Legal Business Name): BEAUTIFUL BRIDGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9540 WOODMAN AVE
ARLETA CA
91331-6416
US

IV. Provider business mailing address

9540 WOODMAN AVE
ARLETA CA
91331-6416
US

V. Phone/Fax

Practice location:
  • Phone: 818-620-5292
  • Fax:
Mailing address:
  • Phone: 818-620-5292
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE D KRIVACEK
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-620-5292