Provider Demographics
NPI:1275959728
Name:TIKVAH CENTER
Entity Type:Organization
Organization Name:TIKVAH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:626-757-4940
Mailing Address - Street 1:22930 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-9148
Mailing Address - Country:US
Mailing Address - Phone:951-254-9736
Mailing Address - Fax:951-254-9737
Practice Address - Street 1:22930 CANYON VIEW DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-9148
Practice Address - Country:US
Practice Address - Phone:951-254-9736
Practice Address - Fax:951-254-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7080251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health