1518521293 NPI number — BREATHING SOL MARRIAGE AND FAMILY THERAPY, INC.

Table of content: (NPI 1518521293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518521293 NPI number — BREATHING SOL MARRIAGE AND FAMILY THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREATHING SOL MARRIAGE AND FAMILY THERAPY, 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:
BREATHING SOL, INC
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:
1518521293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33702 PETUNIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92563-3493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-916-9955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29970 TECHNOLOGY DR STE 117B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92563-2647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-916-9955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
NAXYELI
Authorized Official Middle Name:
SAMANTHA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
951-916-9955

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1902039308 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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