Healthcare Provider Details

I. General information

NPI: 1497686000
Provider Name (Legal Business Name): NEW WAVES VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W COMMONWEALTH AVE STE 104
FULLERTON CA
92832-1751
US

IV. Provider business mailing address

515 W COMMONWEALTH AVE STE 104
FULLERTON CA
92832-1751
US

V. Phone/Fax

Practice location:
  • Phone: 949-522-1469
  • Fax:
Mailing address:
  • Phone: 949-522-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOLTON BECKSTEAD
Title or Position: FOUNDER
Credential:
Phone: 949-522-1469