Healthcare Provider Details

I. General information

NPI: 1083003461
Provider Name (Legal Business Name): ACTIVESTEPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27758 SANTA MARGARITA PKWY BOX 101
MISSION VIEJO CA
92691-6709
US

IV. Provider business mailing address

27758 SANTA MARGARITA PKWY BOX 101
MISSION VIEJO CA
92691-6709
US

V. Phone/Fax

Practice location:
  • Phone: 949-290-3085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CATRINA RODRIGUEZ
Title or Position: OWNER
Credential: MSW
Phone: 949-290-3085