Healthcare Provider Details

I. General information

NPI: 1639737117
Provider Name (Legal Business Name): ACTIVE STEPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 BEACH BLVD STE 100
STANTON CA
90680-3943
US

IV. Provider business mailing address

12235 BEACH BLVD STE 100
STANTON CA
90680-3943
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-0118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL REID
Title or Position: DIRECTOR
Credential:
Phone: 714-202-0118