Healthcare Provider Details

I. General information

NPI: 1538306808
Provider Name (Legal Business Name): CLINIC 4 KIDZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLOUD VIEW TRL
SAUSALITO CA
94965-2061
US

IV. Provider business mailing address

PO BOX 1711
SAUSALITO CA
94966-1711
US

V. Phone/Fax

Practice location:
  • Phone: 415-332-6066
  • Fax: 415-332-6068
Mailing address:
  • Phone: 415-332-6066
  • Fax: 415-332-6068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-00-0346
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-12024
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16743
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2801
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number712332
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11937
License Number StateCA

VIII. Authorized Official

Name: DR. MEETA R PATEL
Title or Position: EXECUTIVE DIRECTOR AND CEO
Credential: PHD, BCBA
Phone: 415-332-6066