Healthcare Provider Details

I. General information

NPI: 1134862683
Provider Name (Legal Business Name): PIONEER LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 W POINT LOMA BLVD
SAN DIEGO CA
92107-1313
US

IV. Provider business mailing address

5022 W POINT LOMA BLVD
SAN DIEGO CA
92107-1313
US

V. Phone/Fax

Practice location:
  • Phone: 619-780-8215
  • Fax: 619-758-9589
Mailing address:
  • Phone: 619-780-8215
  • Fax: 619-758-9589

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: CYNTHIA LIZET FAJARDO
Title or Position: DIRECTOR
Credential: MS, BCBA
Phone: 619-780-8215