Provider Demographics
NPI:1386963213
Name:AULTRUISM, INC.
Entity type:Organization
Organization Name:AULTRUISM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSSIO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:562-889-4256
Mailing Address - Street 1:2043 SAN FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4146
Mailing Address - Country:US
Mailing Address - Phone:562-889-4256
Mailing Address - Fax:
Practice Address - Street 1:10568 MAGNOLIA AVE
Practice Address - Street 2:OFFICE #102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5864
Practice Address - Country:US
Practice Address - Phone:562-889-4256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1084756103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty