Healthcare Provider Details

I. General information

NPI: 1265698880
Provider Name (Legal Business Name): RECOVERY PHYSICIAN GROUP OF CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 W CORDOVA RD STE 818
SANTA FE NM
87505-1825
US

IV. Provider business mailing address

PO BOX 2323
BRENTWOOD TN
37024-2323
US

V. Phone/Fax

Practice location:
  • Phone: 954-587-7771
  • Fax:
Mailing address:
  • Phone: 954-587-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: YVONNE BELL
Title or Position: TEAM LEADER
Credential:
Phone: 954-587-7771