Healthcare Provider Details

I. General information

NPI: 1487363271
Provider Name (Legal Business Name): ASCENT ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9887 SUMMERHILL RD
RANCHO CUCAMONGA CA
91737-1677
US

IV. Provider business mailing address

6649 AMETHYST AVE UNIT 9321
RANCHO CUCAMONGA CA
91701-1557
US

V. Phone/Fax

Practice location:
  • Phone: 909-579-2524
  • Fax:
Mailing address:
  • Phone:
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN CARRILLO
Title or Position: DIRECTOR
Credential: BCBA
Phone: 559-975-9418