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General NPI Number Information
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NPI Number | 1932471661
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Entity Type | Organization
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Legal Business Name | EASTER SEALS
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 1101 S WINCHESTER BLVD STE 120C
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City | SAN JOSE
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State | CA
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Zip | 95128-3901
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Country | US
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Telephone | 510-835-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 S WINCHESTER BLVD STE 120C
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City | SAN JOSE
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State | CA
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Zip | 95128-3901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE COORDINATOR
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Name | MR. CHRIS MACALOON
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Credential |
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Telephone | 510-835-3121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 62008
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License Number State | CA
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