=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033497003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRITTENTON SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2011
-----------------------------------------------------
Last Update Date | 08/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E VALLEY VIEW DR
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92832-1321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-680-8268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 E CHAPMAN AVE STE 203
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92831-3846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-680-8210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERN
-----------------------------------------------------
Name | EDNA FABIOLA PARADA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-636-1133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------