1639316029 NPI number — CALIFORNIA INSTITUTE OF BEHAVIOR ANALYSIS

Table of content: (NPI 1639316029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639316029 NPI number — CALIFORNIA INSTITUTE OF BEHAVIOR ANALYSIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA INSTITUTE OF BEHAVIOR ANALYSIS
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:
Provider Other Organization Name Type Code:
6
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:
1639316029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2127 W ORANGEWOOD AVE
Provider Second Line Business Mailing Address:
#B
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-1954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-634-8500
Provider Business Mailing Address Fax Number:
800-832-2321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2127 W. ORANGEWOOD AVE.
Provider Second Line Business Practice Location Address:
#B
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-634-8500
Provider Business Practice Location Address Fax Number:
800-832-2321
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LUBBERS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
818-442-0921

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC50185 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: BCBA1-01-0404 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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