| Passport To Adaptive Living | |
|
2291 Portola Road Unit A Ventura CA 93003 | |
| (805) 339-0210 | |
| Not Available |
| Full Name | Passport To Adaptive Living |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2291 Portola Road, Ventura, California |
| Authorized Official Name and Position | Jeremy Wilson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8053390210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Passport To Adaptive Living 2291 Portola Road Unit A Ventura CA 93003 Ph: (805) 339-0210 | Passport To Adaptive Living 2291 Portola Road Unit A Ventura CA 93003 Ph: (805) 339-0210 |
| NPI Number | 1922452192 |
|---|---|
| Provider Enumeration Date | 04/14/2016 |
| Last Update Date | 04/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922452192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 0-16-7052 (California) | Primary |
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