Healthcare Provider Details

I. General information

NPI: 1922947647
Provider Name (Legal Business Name): MINDBRIDGEABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N K ST
TULARE CA
93274-4003
US

IV. Provider business mailing address

141 N K ST
TULARE CA
93274-4003
US

V. Phone/Fax

Practice location:
  • Phone: 559-885-3926
  • Fax: 559-885-3926
Mailing address:
  • Phone: 559-754-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: EUNICE BOBO
Title or Position: PROGRAM DIRECTOR
Credential: APCC
Phone: 559-885-3926