Healthcare Provider Details

I. General information

NPI: 1700105079
Provider Name (Legal Business Name): EASTERSEALS NORTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SHADELANDS DRIVE, BLDG. 10
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

2730 SHADELANDS DRIVE, BLDG. 10
WALNUT CREEK CA
94598
US

V. Phone/Fax

Practice location:
  • Phone: 925-266-8400
  • Fax: 510-444-2470
Mailing address:
  • Phone: 925-266-8400
  • Fax: 510-444-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberMFC45876
License Number StateCA

VIII. Authorized Official

Name: MS. ANDREA PETTIFORD
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 925-477-8768