1457567257 NPI number — NEUROBEHAVIORAL HEALTH CARE MED GRP INC

Table of content: (NPI 1457567257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457567257 NPI number — NEUROBEHAVIORAL HEALTH CARE MED GRP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROBEHAVIORAL HEALTH CARE MED GRP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC CRITICAL CARE MED GRP
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457567257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32446 CROWN VALLEY PARKWAY
Provider Second Line Business Mailing Address:
#204
Provider Business Mailing Address City Name:
DANA POINT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92629-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-707-4757
Provider Business Mailing Address Fax Number:
949-488-7840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33971 SELVA RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DANA POINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92629-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-707-4757
Provider Business Practice Location Address Fax Number:
949-488-7840
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOBRIN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
SAMUEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-707-4757

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G 19275 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: G 19275 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: G 19275 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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