Healthcare Provider Details

I. General information

NPI: 1104598374
Provider Name (Legal Business Name): ZINNIA ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3822 CAMPUS DR STE 500
NEWPORT BEACH CA
92660-2674
US

IV. Provider business mailing address

3822 CAMPUS DR STE 500
NEWPORT BEACH CA
92660-2674
US

V. Phone/Fax

Practice location:
  • Phone: 877-262-7803
  • Fax:
Mailing address:
  • Phone: 877-262-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GILBERT YATES
Title or Position: CONTRACT MANAGER
Credential:
Phone: 877-262-7803