Provider Demographics
NPI:1689463804
Name:SPECTRUM OPTIMAL CARE, LLC
Entity type:Organization
Organization Name:SPECTRUM OPTIMAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA - CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:909-295-0388
Mailing Address - Street 1:405 WILSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2928
Mailing Address - Country:US
Mailing Address - Phone:909-295-0388
Mailing Address - Fax:
Practice Address - Street 1:405 WILSHIRE PL
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2928
Practice Address - Country:US
Practice Address - Phone:909-295-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health