Healthcare Provider Details

I. General information

NPI: 1295669877
Provider Name (Legal Business Name): OUR CHILD THERAPY CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23925 CONSTANTINE DR
MURRIETA CA
92562-2140
US

IV. Provider business mailing address

20 PROVIDENCE AVE
LAKEWOOD NJ
08701-5466
US

V. Phone/Fax

Practice location:
  • Phone: 757-866-2715
  • Fax: 877-635-6427
Mailing address:
  • Phone: 757-866-2715
  • Fax: 877-635-6427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MASHE MOSHE
Title or Position: OWNER
Credential:
Phone: 757-866-2715