Healthcare Provider Details

I. General information

NPI: 1700183803
Provider Name (Legal Business Name): CENTRAL VALLEY AUTISM PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 ANTIQUE ROSE WAY
RIVERBANK CA
95367-9505
US

IV. Provider business mailing address

PO BOX 399318
SAN FRANCISCO CA
94139-9318
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-4791
  • Fax: 209-521-4794
Mailing address:
  • Phone: 623-444-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-00-0243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TORI BEJAR
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 623-444-2169