# EASTER SEAL SOCIETY OF SUPERIOR CALIFORNIA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Easter Seals Superior California
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720359490
- **Authorized official:** HOAN NGUYEN (CFO)
- **Authorized official phone:** (916) 485-6711

## Contact information

- **Practice address:** 7273 MURRAY DR STE 1, STOCKTON, CA 95210-3385
- **Practice address phone:** (209) 957-3625
- **Practice address fax:** (209) 957-6031
- **Mailing address:** 3205 HURLEY WAY, SACRAMENTO, CA 95864-3853
- **Mailing address phone:** (916) 485-6711
- **Mailing address fax:** (916) 485-2653

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | — |

## Other

- **Enumeration date:** 01/26/2012
- **Last updated:** 12/07/2018