Healthcare Provider Details

I. General information

NPI: 1174163323
Provider Name (Legal Business Name): KNOWLEDGE OF AUTISM & OTHER DEVELOPMENTAL DISABILITIES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 WHITEBOOK DRIVE
LA HABRA CA
90631
US

IV. Provider business mailing address

14742 BEACH BLVD # 442
LA MIRADA CA
90638-4217
US

V. Phone/Fax

Practice location:
  • Phone: 562-458-0629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA IGARTA
Title or Position: CO-OWNER
Credential: BCBA
Phone: 562-458-0629