Healthcare Provider Details

I. General information

NPI: 1114431392
Provider Name (Legal Business Name): ART AUTISM RELATED THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2017
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10134 6TH ST STE I
RANCHO CUCAMONGA CA
91730-5857
US

IV. Provider business mailing address

10134 6TH ST STE I
RANCHO CUCAMONGA CA
91730-5857
US

V. Phone/Fax

Practice location:
  • Phone: 909-304-1039
  • Fax:
Mailing address:
  • Phone: 909-304-1039
  • 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 Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA PALOMO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 626-664-8379