Healthcare Provider Details

I. General information

NPI: 1124165774
Provider Name (Legal Business Name): DEPARTMENT OF BEHAVIOUR HEALTH, SB COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9378
  • Fax: 909-421-9494
Mailing address:
  • Phone: 909-421-9378
  • Fax: 909-421-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLCS7515
License Number StateCA

VIII. Authorized Official

Name: MR. RAJENDRA KUMAR LALL
Title or Position: MH CLINICIAN 3
Credential: LCSW
Phone: 909-421-9378