NPIMap

Organization Active NPI

Inland Empire Autism Assessment Center, a Psychological Corporation

  • Clinical Neuropsychologist
  • Riverside, CA
National Provider Identifier
1467005579
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
Legal business name
INLAND EMPIRE AUTISM ASSESSMENT CENTER, A PSYCHOLOGICAL CORPORATION
Practice address
19314 Jesse LN Ste 200
Riverside, CA 92508-5070
Phone
(909) 799-3777
Fax
(909) 799-5999
NPI assigned
Jul 17, 2019
Last updated
Aug 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Zachary Dane GinderNPI 1437486412
Title
Authorized Representative
Phone
(909) 799-3777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X NU Primary
Psychologist 103T00000X NU
Clinical Psychologist 103TC0700X NU
Specialist 174400000X NU
Pediatric Neurodevelopmental Disabilities Physician 2080P0008X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

19314 Jesse LN Ste 200
Riverside, CA 92508-5070

Mailing address

19314 Jesse LN Ste 200
Riverside, CA 92508-5070
Phone (909) 799-3777

Other practice location 1

1499 S Tippecanoe Ave Bldg A
San Bernardino, CA 92408-2920
Phone (909) 799-3777

National Provider Directory

National Provider Directory

Locations

19314 Jesse Ln
Ste 200
Riverside, CA 92508
Phone (909) 799-3777

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1467005579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19314 JESSE LN STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085070",
            "telephone_number": "909-799-3777",
            "fax_number": "909-799-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19314 JESSE LN STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925085070",
            "telephone_number": "909-799-3777",
            "fax_number": "909-799-5999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1499 S Tippecanoe Ave Bldg A",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924082920",
            "country_code": "US",
            "telephone_number": "909-799-3777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INLAND EMPIRE AUTISM ASSESSMENT CENTER, A PSYCHOLOGICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-17",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "GINDER",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "DANE",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "909-799-3777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.