Healthcare Provider Details

I. General information

NPI: 1831844380
Provider Name (Legal Business Name): JANINE RENEE BELL CADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50770 APACHE TRL
MORONGO VALLEY CA
92256-9193
US

IV. Provider business mailing address

PO BOX 1014
MORONGO VALLEY CA
92256-1014
US

V. Phone/Fax

Practice location:
  • Phone: 310-775-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: