Provider Demographics
NPI:1003453275
Name:BLUE AUTISM CENTER
Entity Type:Organization
Organization Name:BLUE AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:UCHOA
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:925-338-4764
Mailing Address - Street 1:1233 W BRISTER DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7927
Mailing Address - Country:US
Mailing Address - Phone:925-338-4764
Mailing Address - Fax:
Practice Address - Street 1:1233 W BRISTER DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-7927
Practice Address - Country:US
Practice Address - Phone:925-338-4764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty