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General NPI Number Information
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NPI Number | 1841136801
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Entity Type | Organization
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Legal Business Name | EASTERSEALS SOUTHERN CALIFORNIA
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 4688 ONTARIO MILLS PKWY
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City | ONTARIO
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State | CA
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Zip | 91764-5104
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Country | US
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Telephone | 909-476-5747
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Fax |
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Provider Business Mailing Address
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Address Line | 4688 ONTARIO MILLS PKWY
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City | ONTARIO
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State | CA
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Zip | 91764-5104
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Country | US
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Telephone | 909-476-5747
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | MARK WHITLEY
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Credential |
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Telephone | 741-834-1111
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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 |
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License Number State |
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