Healthcare Provider Details

I. General information

NPI: 1619255841
Provider Name (Legal Business Name): EASTER SEALS SOUTHERN CALIFORNIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 MCGAW AVE STE 100
IRVINE CA
92614-5554
US

IV. Provider business mailing address

1063 MCGAW AVE STE 100
IRVINE CA
92614-5554
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