Healthcare Provider Details

I. General information

NPI: 1336926732
Provider Name (Legal Business Name): AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W F ST
ONTARIO CA
91762-3205
US

IV. Provider business mailing address

317 W F ST
ONTARIO CA
91762-3205
US

V. Phone/Fax

Practice location:
  • Phone: 714-325-5621
  • Fax: 909-391-3068
Mailing address:
  • Phone: 714-325-5621
  • Fax: 909-391-3068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: PARDIS AMIRHOUSHMAND
Title or Position: CEO
Credential:
Phone: 714-325-5621