=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861384208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOPHRON AUTISM SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2025
-----------------------------------------------------
Last Update Date | 07/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 BORELLO WAY
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94041-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-224-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2872 SYCAMORE WAY
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051-5664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-224-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | BHARAT SAIJU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-996-6468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------