Healthcare Provider Details

I. General information

NPI: 1255837217
Provider Name (Legal Business Name): SHAWN PATRICK RIMBACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE
ORANGE CA
92868-4402
US

IV. Provider business mailing address

1160 BRYAN AVE APT A
TUSTIN CA
92780-8101
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-9295
  • Fax:
Mailing address:
  • Phone: 949-371-1391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: