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General NPI Number Information
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NPI Number | 1740573690
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Entity Type | Organization
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Legal Business Name | EASTER SEALS SOUTHERN CALIFORNIA, INC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 500 W CENTRAL AVE STE A
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City | BREA
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State | CA
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Zip | 92821-3027
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Country | US
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Telephone | 714-834-1111
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Fax | 714-834-1128
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Provider Business Mailing Address
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Address Line | 1801 E EDINGER AVE STE 190
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City | SANTA ANA
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State | CA
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Zip | 92705-4754
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Country | US
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Telephone | 714-834-1111
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Fax | 714-834-1128
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Authorized Official
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Title or Position | CFO
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Name | SUSAN BERGLUND
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Credential |
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Telephone | 714-834-1111
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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 |
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License Number State |
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