Healthcare Provider Details

I. General information

NPI: 1740573690
Provider Name (Legal Business Name): EASTER SEALS SOUTHERN CALIFORNIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W CENTRAL AVE STE A
BREA CA
92821-3027
US

IV. Provider business mailing address

1801 E EDINGER AVE STE 190
SANTA ANA CA
92705-4754
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1111
  • Fax: 714-834-1128
Mailing address:
  • Phone: 714-834-1111
  • Fax: 714-834-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BERGLUND
Title or Position: CFO
Credential:
Phone: 714-834-1111