Healthcare Provider Details

I. General information

NPI: 1477345437
Provider Name (Legal Business Name): PEDIATRIC INTEGRATIVE THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S MYRTLE AVE STE 204
MONROVIA CA
91016-6145
US

IV. Provider business mailing address

525 S MYRTLE AVE STE 204
MONROVIA CA
91016-6145
US

V. Phone/Fax

Practice location:
  • Phone: 626-471-5519
  • Fax:
Mailing address:
  • Phone: 626-471-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA AARONSON
Title or Position: OWNER
Credential: NP
Phone: 408-265-3101