NPIMap

Organization Active NPI

Inland Empire Autism Spectrum Disorder Assessment Center of Excellence

  • Clinical Neuropsychologist
  • San Bernardino, CA
National Provider Identifier
1689031528
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PSY24993 Issued in CA
Legal business name
INLAND EMPIRE AUTISM SPECTRUM DISORDER ASSESSMENT CENTER OF EXCELLENCE
Practice address
1499 S Tippecanoe Ave Building a
San Bernardino, CA 92415-0024
Phone
(909) 799-3777
Fax
(909) 799-5999
NPI assigned
Jan 22, 2016
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
Zachary Dane Ginder, PSYD, MSWNPI 1437486412
Title
Executive Director
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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PSY24993 CA Primary
Psychologist 103T00000X PSY15160 CA
Psychologist 103T00000X PSY23181 CA
Psychologist 103T00000X PSY25134 CA
Specialist 174400000X G46919 CA
Specialist 174400000X A118211 CA
Specialist 174400000X A239458 CA
Occupational Therapist 225X00000X 2683 CA

Addresses

Primary practice location

1499 S Tippecanoe Ave Building a
San Bernardino, CA 92415-0024

Mailing address

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

Other practice location 1

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

National Provider Directory

National Provider Directory

Locations

1499 S Tippecanoe Ave
Bldg A
San Bernardino, CA 92408
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": "1453420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1689031528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 S TIPPECANOE AVE BLDG A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082920",
            "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": "1499 S TIPPECANOE AVE BUILDING A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150024",
            "telephone_number": "909-799-3777",
            "fax_number": "909-799-5999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19314 Jesse Ln Ste 200",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925085070",
            "country_code": "US",
            "telephone_number": "909-799-3777",
            "fax_number": "909-799-5999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INLAND EMPIRE AUTISM SPECTRUM DISORDER ASSESSMENT CENTER OF EXCELLENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-22",
        "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": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "909-799-3777",
        "authorized_official_credential": "PSYD, MSW"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY24993",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY15160",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY23181",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY25134",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G46919",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A118211",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A239458",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "2683",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, 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.