Healthcare Provider Details

I. General information

NPI: 1619513892
Provider Name (Legal Business Name): MEBE SAN FRANCISCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 PATRICK HENRY DR BLDG 25
SANTA CLARA CA
95054-1863
US

IV. Provider business mailing address

8885 RIO SAN DIEGO DR STE 340
SAN DIEGO CA
92108-1669
US

V. Phone/Fax

Practice location:
  • Phone: 619-795-9925
  • Fax: 877-602-5087
Mailing address:
  • Phone: 619-795-9925
  • Fax: 877-602-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. ABBY BUNT
Title or Position: EXECUTIVE CLINICAL DIRECTOR
Credential:
Phone: 619-795-9925