Healthcare Provider Details

I. General information

NPI: 1528394962
Provider Name (Legal Business Name): BEYOND BLINDNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18542-B VANDERLIP AVE.
SANTA ANA CA
92705
US

IV. Provider business mailing address

18542-B VANDERLIP AVE.
SANTA ANA CA
92705
US

V. Phone/Fax

Practice location:
  • Phone: 714-573-8888
  • Fax: 714-573-8875
Mailing address:
  • Phone: 714-573-8888
  • Fax: 714-573-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number300614053
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number300614054
License Number StateCA

VIII. Authorized Official

Name: ANGIE ROWE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 714-573-8888