Healthcare Provider Details

I. General information

NPI: 1205343076
Provider Name (Legal Business Name): MOMENTUM LEARNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 EL CAJON BLVD.
SD CA
92105
US

IV. Provider business mailing address

3288 EL CAJON BLVD #13
SD CA
92104
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-5720
  • Fax: 619-521-5728
Mailing address:
  • Phone: 619-521-5720
  • Fax: 619-521-5728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name: SUNNYO PAK
Title or Position: PROGRAM MANAGER
Credential: MFT
Phone: 619-521-5720