Provider Demographics
NPI:1861716854
Name:PROFESSIONAL ASSESSMENT AND TREATMENT SERVICES
Entity type:Organization
Organization Name:PROFESSIONAL ASSESSMENT AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW, PSYD
Authorized Official - Phone:626-665-7354
Mailing Address - Street 1:12204 N MAINSTREET
Mailing Address - Street 2:#1
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8691
Mailing Address - Country:US
Mailing Address - Phone:626-665-7354
Mailing Address - Fax:909-803-0384
Practice Address - Street 1:12204 N MAINSTREET
Practice Address - Street 2:#1
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8691
Practice Address - Country:US
Practice Address - Phone:626-665-7354
Practice Address - Fax:909-803-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 24862251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health