Healthcare Provider Details

I. General information

NPI: 1598305237
Provider Name (Legal Business Name): FAITH LA BELLA RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 10TH ST
RIVERSIDE CA
92501-3617
US

IV. Provider business mailing address

3499 10TH ST
RIVERSIDE CA
92501-3617
US

V. Phone/Fax

Practice location:
  • Phone: 951-452-2372
  • Fax: 951-849-1762
Mailing address:
  • Phone: 951-452-2372
  • Fax: 951-849-1762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1483600922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: