Healthcare Provider Details

I. General information

NPI: 1730756586
Provider Name (Legal Business Name): AMPLE JOY ABA CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 WILSHIRE BLVD STE 1049
LOS ANGELES CA
90036-4203
US

IV. Provider business mailing address

14605 RICK LN
EASTVALE CA
92880-3544
US

V. Phone/Fax

Practice location:
  • Phone: 877-708-2385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: NNEKA NWANI
Title or Position: OWNER
Credential:
Phone: 951-801-0549