Healthcare Provider Details

I. General information

NPI: 1932399888
Provider Name (Legal Business Name): BETTY M. REDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 N E ST
SAN BERNARDINO CA
92405-3919
US

IV. Provider business mailing address

1963 N E ST
SAN BERNARDINO CA
92405-3919
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-6146
  • Fax: 909-881-0111
Mailing address:
  • Phone: 909-881-6146
  • Fax: 909-881-0111

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: