Healthcare Provider Details

I. General information

NPI: 1962124941
Provider Name (Legal Business Name): BELLATOR PSYCHOLOGICAL AND CONSULTANTS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 BROCKTON AVE STE 202
RIVERSIDE CA
92506-2207
US

IV. Provider business mailing address

8799 BALBOA AVE STE 255
SAN DIEGO CA
92123-1581
US

V. Phone/Fax

Practice location:
  • Phone: 858-583-6188
  • Fax: 951-224-9900
Mailing address:
  • Phone: 858-583-6188
  • Fax: 951-224-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE DABDOUB
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 858-583-6197