Healthcare Provider Details

I. General information

NPI: 1407679335
Provider Name (Legal Business Name): SARAF SHMUTZ APCC 16213
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

2304 ALTISMA WAY UNIT 207
CARLSBAD CA
92009-6381
US

V. Phone/Fax

Practice location:
  • Phone: 888-688-0248
  • Fax:
Mailing address:
  • Phone: 909-317-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC16213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: