Healthcare Provider Details

I. General information

NPI: 1326352675
Provider Name (Legal Business Name): CENTER FOR DEVELOPING KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 09/09/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6617
US

IV. Provider business mailing address

2555 E COLORADO BLVD STE 100
PASADENA CA
91107-6617
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-2700
  • Fax:
Mailing address:
  • Phone: 626-564-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberOT1332
License Number StateCA

VIII. Authorized Official

Name: ANJALI KOESTER
Title or Position: DIRECTOR
Credential: OTD
Phone: 626-564-2700