Healthcare Provider Details

I. General information

NPI: 1679858203
Provider Name (Legal Business Name): AUTISM INTERVENTIONS AND RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23241 SOUTH POINTE DRIVE
LAGUNA HILLS CA
92653-1367
US

IV. Provider business mailing address

23241 SOUTH POINTE DRIVE
LAGUNA HILLS CA
92653-1367
US

V. Phone/Fax

Practice location:
  • Phone: 949-457-9203
  • Fax: 949-457-9213
Mailing address:
  • Phone: 949-457-9203
  • Fax: 949-457-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANAHITA P RENNER
Title or Position: CEO
Credential: BCBA
Phone: 949-457-9203