| 1380 Llc | |
|
11324 Amigo Ave Porter Ranch CA 91326-2118 | |
| (818) 688-2183 | |
| (213) 933-4631 |
| Full Name | 1380 Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 11324 Amigo Ave, Porter Ranch, California |
| Authorized Official Name and Position | Robert Rudolph (CFO) |
| Authorized Official Contact | 8186882183 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1380 Llc Po Box 7485 Van Nuys CA 91409-7485 Ph: (818) 688-2183 | 1380 Llc 11324 Amigo Ave Porter Ranch CA 91326-2118 Ph: (818) 688-2183 |
| NPI Number | 1427945252 |
|---|---|
| Provider Enumeration Date | 06/23/2025 |
| Last Update Date | 06/23/2025 |
| Certification Date | 06/23/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427945252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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