Healthcare Provider Details

I. General information

NPI: 1316875651
Provider Name (Legal Business Name): KAIZEN BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16582 CALIFORNIA STREET
TUSTIN CA
92780
US

IV. Provider business mailing address

16582 CALIFORNIA STREET
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-856-9505
  • Fax:
Mailing address:
  • Phone: 714-856-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIAH SERRANO-LAI
Title or Position: CEO
Credential: BCBA
Phone: 714-856-9505