1700183803 NPI number — CENTRAL VALLEY AUTISM PROJECT, INC.

Table of content: (NPI 1700183803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700183803 NPI number — CENTRAL VALLEY AUTISM PROJECT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL VALLEY AUTISM PROJECT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CVAP
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700183803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399318
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94139-9318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-444-2169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 ANTIQUE ROSE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95367-9505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-521-4791
Provider Business Practice Location Address Fax Number:
209-521-4794
Provider Enumeration Date:
02/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BEJAR
Authorized Official First Name:
TORI
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
623-444-2169

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-00-0243 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com