1457567257 NPI number — NEUROBEHAVIORAL HEALTH CARE MED GRP INC

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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)