Healthcare Provider Details

I. General information

NPI: 1366898488
Provider Name (Legal Business Name): EXPLORER DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PALOMAR AIRPORT RD STE 300
CARLSBAD CA
92011-1028
US

IV. Provider business mailing address

701 PALOMAR AIRPORT RD STE 300
CARLSBAD CA
92011-1028
US

V. Phone/Fax

Practice location:
  • Phone: 858-381-7741
  • Fax: 858-210-6369
Mailing address:
  • Phone: 858-381-7741
  • Fax: 858-210-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name: SABRINA AVANTS
Title or Position: EXECUTIVE DIRECTOR/CO-FOUNDER
Credential:
Phone: 858-381-7741