Provider Demographics
NPI:1467005579
Name:INLAND EMPIRE AUTISM ASSESSMENT CENTER, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:INLAND EMPIRE AUTISM ASSESSMENT CENTER, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:GINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-799-3777
Mailing Address - Street 1:19314 JESSE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5070
Mailing Address - Country:US
Mailing Address - Phone:909-799-3777
Mailing Address - Fax:909-799-5999
Practice Address - Street 1:19314 JESSE LN STE 200
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5070
Practice Address - Country:US
Practice Address - Phone:909-799-3777
Practice Address - Fax:909-799-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty