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General NPI Number Information
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NPI Number | 1518347426
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Entity Type | Organization
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Legal Business Name | NY LEARNING CENTER
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 4908 KIRK LANE
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City | SAN PABLO
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State | CA
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Zip | 94806
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Country | US
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Telephone | 510-236-2146
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Fax | 510-236-1249
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Provider Business Mailing Address
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Address Line | 4908 KIRK LANE
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City | SAN PABLO
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State | CA
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Zip | 94806
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Country | US
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Telephone | 510-236-2146
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Fax | 510-236-1249
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR / OWNER
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Name | YASMIN LOZANO
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Credential |
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Telephone | 510-236-2146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 073405681
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License Number State | CA
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