Provider Demographics
NPI:1336435734
Name:PACIFIC AUTISM LEARNING SERVICES, INC
Entity Type:Organization
Organization Name:PACIFIC AUTISM LEARNING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA-D
Authorized Official - Phone:916-676-0488
Mailing Address - Street 1:1328 BLUE OAKS BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7031
Mailing Address - Country:US
Mailing Address - Phone:916-676-0488
Mailing Address - Fax:916-771-4370
Practice Address - Street 1:1710 S AMPHLETT BLVD
Practice Address - Street 2:STE 314
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2703
Practice Address - Country:US
Practice Address - Phone:650-242-0179
Practice Address - Fax:650-242-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health