=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336519487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALIFORNIA AUTISM INITIATIVE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2015
-----------------------------------------------------
Last Update Date | 10/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 FISHER RD NE APT# 333
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97305-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-718-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3535 FISHER RD NE APT# 333
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97305-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-718-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MISS CARMEN ROJAS LARRAZABAL
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 661-718-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 584812
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------