Healthcare Provider Details

I. General information

NPI: 1083074066
Provider Name (Legal Business Name): MS. CRYSTAL BEBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 MILLS AVE
WHITTIER CA
90604-2440
US

IV. Provider business mailing address

10511 MILLS AVE.
WHITTIER CA
90604
US

V. Phone/Fax

Practice location:
  • Phone: 562-944-7953
  • Fax: 562-946-7494
Mailing address:
  • Phone: 562-944-7953
  • Fax: 562-946-7494

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: