Provider Demographics
NPI:1366898488
Name:EXPLORER DEVELOPMENT CENTER
Entity type:Organization
Organization Name:EXPLORER DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-381-7741
Mailing Address - Street 1:701 PALOMAR AIRPORT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1028
Mailing Address - Country:US
Mailing Address - Phone:858-381-7741
Mailing Address - Fax:858-210-6369
Practice Address - Street 1:701 PALOMAR AIRPORT RD STE 300
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1028
Practice Address - Country:US
Practice Address - Phone:858-381-7741
Practice Address - Fax:858-210-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-07
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X, 225X00000X, 235Z00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty