Healthcare Provider Details

I. General information

NPI: 1881175081
Provider Name (Legal Business Name): T&K INNOVATORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 08/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W MAIN ST STE P2
VISALIA CA
93291-6267
US

IV. Provider business mailing address

3755 W FLAGSTAFF AVE
VISALIA CA
93291-9373
US

V. Phone/Fax

Practice location:
  • Phone: 323-397-4758
  • Fax:
Mailing address:
  • Phone: 323-397-4758
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA VALENZUELA
Title or Position: CEO
Credential:
Phone: 323-397-4758