Healthcare Provider Details

I. General information

NPI: 1013425065
Provider Name (Legal Business Name): INTERVENTION CENTER FOR AUTISM NEEDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MIRAMONTE AVE STE 3
MOUNTAIN VIEW CA
94040-3718
US

IV. Provider business mailing address

1704 MIRAMONTE AVE STE 3
MOUNTAIN VIEW CA
94040-3718
US

V. Phone/Fax

Practice location:
  • Phone: 833-222-4226
  • Fax:
Mailing address:
  • Phone: 833-222-4226
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SABA TORABIAN
Title or Position: OWNER
Credential: PHD
Phone: 650-930-9550