Healthcare Provider Details

I. General information

NPI: 1902048085
Provider Name (Legal Business Name): I CAN TOO LEARNING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 PARKMOOR AVE STE A
SAN JOSE CA
95128-2422
US

IV. Provider business mailing address

1520 PARKMOOR AVE STE A
SAN JOSE CA
95128-2422
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-9911
  • Fax: 408-241-7788
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARA GALLAGHER
Title or Position: DIRECTOR OF OFFICE MANAGMENT
Credential:
Phone: 408-241-9911