Healthcare Provider Details

I. General information

NPI: 1295219426
Provider Name (Legal Business Name): RESURFACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20101 SW BIRCH ST STE 278
NEWPORT BEACH CA
92660-0778
US

IV. Provider business mailing address

2900 BRISTOL ST STE B320
COSTA MESA CA
92626-5987
US

V. Phone/Fax

Practice location:
  • Phone: 949-351-8558
  • Fax:
Mailing address:
  • Phone: 949-351-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ARI DROSMAN
Title or Position: OWNER
Credential: LMFT
Phone: 949-351-8558