Healthcare Provider Details

I. General information

NPI: 1871628750
Provider Name (Legal Business Name): DEPARTMENT OF BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E MOUNTAIN VIEW ST
BARSTOW CA
92311-3033
US

IV. Provider business mailing address

805 E MOUNTAIN VIEW ST
BARSTOW CA
92311-3033
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-5026
  • Fax: 760-256-5092
Mailing address:
  • Phone: 760-256-5026
  • Fax: 760-256-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN MICHAEL MONTOYA
Title or Position: SOCIAL WORKER II
Credential: BA
Phone: 760-256-5026