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General NPI Number Information
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NPI Number | 1508307125
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Entity Type | Organization
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Legal Business Name | POSITIVE BEHAVIOR SUPPORT CORP.
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 563 BALBOA AVENUE #521
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City | SAN DIEGO
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State | CA
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Zip | 92111
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Country | US
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Telephone | 253-732-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 563 BALBOA AVENUE 521
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City | SAN DIEGO
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State | CA
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Zip | 92111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED BEHAVIOR TECHNICIAN
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Name | KASANDRA RENEE FLORES
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Credential | RBT
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Telephone | 253-732-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 106S00000X
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License Number State | CA
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