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1744 E Thackery St West Covina CA 91791-3137 | |
| (323) 943-4400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1744 E Thackery St, West Covina, California |
| Authorized Official Name and Position | Jack Lopez (BCBA/CLINICAL DIRECTOR) |
| Authorized Official Contact | 3239434400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1050 Lakes Dr #225 Pmb #3097 West Covina CA 91790 Ph: () - | 1744 E Thackery St West Covina CA 91791-3137 Ph: (323) 943-4400 |
| NPI Number | 1477378461 |
|---|---|
| Provider Enumeration Date | 11/15/2024 |
| Last Update Date | 01/24/2025 |
| Certification Date | 01/24/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477378461 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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