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General NPI Number Information
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NPI Number | 1881958999
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Entity Type | Organization
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Legal Business Name | EDUCATIONAL ADVANTAGE LLC
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 448 E FOOTHILL BLVD SUITE 204
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City | SAN DIMAS
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State | CA
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Zip | 91773-1205
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Country | US
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Telephone | 909-394-0823
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Fax | 909-693-5452
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Provider Business Mailing Address
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Address Line | 448 E FOOTHILL BLVD SUITE 204
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City | SAN DIMAS
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State | CA
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Zip | 91773-1205
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Country | US
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Telephone | 909-394-0823
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Fax | 909-693-5452
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN SAMANIEGO
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Credential |
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Telephone | 800-581-8045
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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 | CA
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