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General NPI Number Information
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NPI Number | 1023403714
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Entity Type | Organization
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Legal Business Name | NDR PACIFIC, INC
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 24482 CARACAS ST
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City | DANA POINT
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State | CA
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Zip | 92629-1320
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Country | US
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Telephone | 949-218-8174
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Fax | 866-703-9903
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Provider Business Mailing Address
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Address Line | 806 AVENIDA PICO SUITE I-284
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-5639
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Country | US
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Telephone | 949-235-8258
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Fax | 866-703-9903
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | REINER VINCENT NUSBAUM
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Credential |
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Telephone | 949-235-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 300306AP
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 300306AP
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 300306AP
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300306AP
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License Number State | CA
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