Healthcare Provider Details

I. General information

NPI: 1912707506
Provider Name (Legal Business Name): AUTISM CARE PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 INDIANA AVE
PUEBLO CO
81004-3747
US

IV. Provider business mailing address

2001 ECHO PL
SAN RAMON CA
94582-4832
US

V. Phone/Fax

Practice location:
  • Phone: 833-666-2919
  • Fax: 833-666-3114
Mailing address:
  • Phone: 833-666-2919
  • Fax: 833-666-3114

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
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUDDHA MUKHOPADHYAY
Title or Position: DIRECTOR
Credential:
Phone: 213-425-4324