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NPI Code Detail

MEDICARE: PEDIATRIC NEUROLOGY THERAPEUTICS

MEDICARE: PEDIATRIC NEUROLOGY THERAPEUTICS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst11624696CA

General Provider Information

NPI Number : 1124559950
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC NEUROLOGY THERAPEUTICS
Provider Business Mailing Address
First Line : 7090 MIRATECH DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3109
Country : US
Telephone Number : 858-304-6440
Fax Number :
Provider Business Practice Location Address
First Line : 7090 MIRATECH DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-3109
Country : US
Telephone Number : 858-304-6440
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MS. MELISSA DANIELLE KNOPP
Credential : M.S., BCBA
Telephone Number : 201-819-1499
Provider Enumeration Date : 03/23/2017
Last Update Date : 03/23/2017

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Directions to “PEDIATRIC NEUROLOGY THERAPEUTICS ” Practice Location

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