Healthcare Provider Details

I. General information

NPI: 1346700697
Provider Name (Legal Business Name): FAMILY CARE SPECTRUM THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 KILROY AIRPORT WAY STE 200
LONG BEACH CA
90806-2458
US

IV. Provider business mailing address

PO BOX 1851
SOUTH GATE CA
90280-1851
US

V. Phone/Fax

Practice location:
  • Phone: 323-548-8820
  • Fax: 323-978-6842
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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CRISTIAN GANDARA
Title or Position: EXECUTIVE CLINICAL DIRECTOR / CEO
Credential: BCBA
Phone: 323-548-8820