Healthcare Provider Details

I. General information

NPI: 1407160500
Provider Name (Legal Business Name): OTHERS INTERNATIONAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N E ST 107
SAN BERNARDINO CA
92401-1540
US

IV. Provider business mailing address

11171 OAKWOOD DR K406
LOMA LINDA CA
92354-4802
US

V. Phone/Fax

Practice location:
  • Phone: 909-649-7261
  • Fax:
Mailing address:
  • Phone: 909-649-7261
  • Fax: 909-796-2537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS20457
License Number StateCA

VIII. Authorized Official

Name: MRS. SHIRLEY HUNT WIGGINS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 909-649-7261