Healthcare Provider Details

I. General information

NPI: 1568261832
Provider Name (Legal Business Name): AUTONOMOUS BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD STE 304
HARBOR CITY CA
90710-2085
US

IV. Provider business mailing address

3217 CARSON ST # 1002
LAKEWOOD CA
90712-4006
US

V. Phone/Fax

Practice location:
  • Phone: 323-792-2540
  • Fax: 562-724-9887
Mailing address:
  • Phone:
  • Fax: 562-724-9887

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: JAVON MAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-792-2540