Healthcare Provider Details

I. General information

NPI: 1225707938
Provider Name (Legal Business Name): INNOVATING BEHAVIORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E ORANGEBURG AVE STE 16
MODESTO CA
95350-5340
US

IV. Provider business mailing address

121 E ORANGEBURG AVE STE 16
MODESTO CA
95350-5340
US

V. Phone/Fax

Practice location:
  • Phone: 760-905-2479
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ISABEL JIMENEZ
Title or Position: CLINICAL SUPERVISOR
Credential:
Phone: 209-585-3321