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General NPI Number Information
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NPI Number | 1902479520
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Entity Type | Organization
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Legal Business Name | PIVOT BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 490 43RD ST # 38
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City | OAKLAND
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State | CA
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Zip | 94609-2138
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Country | US
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Telephone | 510-900-3103
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Fax |
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Provider Business Mailing Address
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Address Line | 490 43RD ST # 38
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City | OAKLAND
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State | CA
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Zip | 94609-2138
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Country | US
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Telephone | 510-900-3103
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SERGIO GUSTAVO VASQUEZ
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Credential |
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Telephone | 501-356-0473
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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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