Provider Demographics
NPI:1588932412
Name:PROOF POSITIVE ABA THERAPIES
Entity type:Organization
Organization Name:PROOF POSITIVE ABA THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:GRIMALDI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:949-246-9292
Mailing Address - Street 1:3313 PARK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3850
Mailing Address - Country:US
Mailing Address - Phone:949-910-6767
Mailing Address - Fax:
Practice Address - Street 1:3313 PARK DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3850
Practice Address - Country:US
Practice Address - Phone:949-910-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-8836251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid