Provider Demographics
NPI:1811383839
Name:INSPIRA BEHAVIOR AND ADVOCACY SPECIALISTS
Entity Type:Organization
Organization Name:INSPIRA BEHAVIOR AND ADVOCACY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-606-1349
Mailing Address - Street 1:1730 E HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4404
Mailing Address - Country:US
Mailing Address - Phone:844-467-7763
Mailing Address - Fax:
Practice Address - Street 1:1730 E HOLLY AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4404
Practice Address - Country:US
Practice Address - Phone:844-467-7763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15186103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty