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General NPI Number Information
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NPI Number | 1467256768
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Entity Type | Individual
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Provider Name | ROBERT CONNORS RADT
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Gender | Male
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 13222 CHAPMAN AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4414
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Country | US
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Telephone | 310-780-1667
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Fax |
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Provider Business Mailing Address
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Address Line | 17326 SANTA ISABEL ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3111
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Country | US
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Telephone | 516-551-6988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | R1606100425
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License Number State | CA
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