Provider Demographics
NPI:1538306808
Name:CLINIC 4 KIDZ
Entity Type:Organization
Organization Name:CLINIC 4 KIDZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEETA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:415-332-6066
Mailing Address - Street 1:PO BOX 1711
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-1711
Mailing Address - Country:US
Mailing Address - Phone:415-332-6066
Mailing Address - Fax:415-332-6068
Practice Address - Street 1:7 CLOUD VIEW TRL
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2061
Practice Address - Country:US
Practice Address - Phone:415-332-6066
Practice Address - Fax:415-332-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-00-0346103K00000X
CA1-12-12024103K00000X
CA1-14-16743103K00000X
MN2801133N00000X
CA712332133VN1004X
CA11937235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty