OrganizationActive
Educational Therapy Assessment & Services
NPI 1790029312 · Developmental Disabilities Clinic/Center · Yucaipa, CA
Provider details
- NPI number
- 1790029312
- Entity type
- Organization
- Primary specialty
- Developmental Disabilities Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Doreen Spearman, President/Executive Director(909) 795-4255
Specialties & taxonomies
Ambulatory Health Care Facilities
- Pediatric Physical Therapist2251P0200X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Speech-Language Pathologist235Z00000X
Speech, Language and Hearing Service Providers
Ambulatory Health Care Facilities
Practice location
34590 County Line Rd
Suite 7
Yucaipa, CA 92399-5303
Phone: (909) 795-4255
Fax: (909) 795-4438
Approximate (ZIP-level) locationGet directions
Mailing address
34590 County Line Rd
Yucaipa, CA 92399-5303
Other names (DBA / former)
- Doing business as
- Etas
Registry dates
- Enumerated
- 2012-11-20
- Last updated
- 2012-11-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.