Healthcare Provider Details

I. General information

NPI: 1154818037
Provider Name (Legal Business Name): LITTLE LEARNERS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23873 CLINTON KEITH RD STE 103
WILDOMAR CA
92595-9735
US

IV. Provider business mailing address

24312 ROSITA DR
WILDOMAR CA
92595-7892
US

V. Phone/Fax

Practice location:
  • Phone: 951-200-5532
  • Fax: 951-271-9542
Mailing address:
  • Phone: 951-837-7480
  • Fax: 951-271-9542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAUREN CHRISTINE ESPINOSA
Title or Position: OWNER
Credential: M.S.
Phone: 951-200-5532