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General NPI Number Information
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NPI Number | 1407000896
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PATHWAYS INC.
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 14895 E 14TH ST SUITE 465
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2922
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Country | US
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Telephone | 510-206-2030
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Fax | 510-346-7101
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Provider Business Mailing Address
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Address Line | 1534 PLAZA LN SUITE 358
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City | BURLINGAME
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State | CA
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Zip | 94010-3204
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Country | US
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Telephone | 510-206-2030
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Fax | 650-259-0332
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. BAHRIG MIKAELIAN
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Credential | MA
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Telephone | 510-206-2030
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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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