Healthcare Provider Details

I. General information

NPI: 1205701927
Provider Name (Legal Business Name): SUPERSTAR ABA CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 EL CAJON BLVD
EL CAJON CA
92020-4312
US

IV. Provider business mailing address

624 EL CAJON BLVD
EL CAJON CA
92020-4312
US

V. Phone/Fax

Practice location:
  • Phone: 619-310-6600
  • Fax:
Mailing address:
  • Phone: 619-310-6600
  • Fax: 619-923-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. TONY TATARI
Title or Position: COO
Credential:
Phone: 619-847-8835