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General NPI Number Information
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NPI Number | 1184495020
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Entity Type | Organization
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Legal Business Name | OMOTO ABA CONSULTING, LLC
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Dates
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Enumeration Date | 01/10/2024
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 5111 DIANE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92117-1356
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Country | US
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Telephone | 916-549-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 3952D CLAIREMONT MESA BLVD # 387
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City | SAN DIEGO
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State | CA
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Zip | 92117-2714
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Country | US
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Telephone | 619-215-1949
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARTIN JASON OMOTO
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Credential | MS, BCBA
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Telephone | 619-215-1949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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