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General NPI Number Information
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NPI Number | 1548755283
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Entity Type | Organization
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Legal Business Name | IMPERIAL VALLEYRESPITE, INC.
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 630 S. IMPERIAL AVE., STE. 2
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City | BRAWLEY
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State | CA
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Zip | 92227
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Country | US
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Telephone | 760-351-0825
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Fax | 707-561-7746
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Provider Business Mailing Address
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Address Line | 630 S. IMPERIAL AVE., STE. 2
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City | BRAWLEY
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State | CA
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Zip | 92227
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Country | US
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Telephone | 760-351-0825
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Fax | 707-561-7746
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Authorized Official
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Title or Position | CHIEF EXECUTIVE DIRECTOR
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Name | MRS. CATALINA A SANTILLA
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Credential |
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Telephone | 760-351-0825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-26978
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License Number State | CA
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