=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073001681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN RECOVERY CENTERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2018
-----------------------------------------------------
Last Update Date | 02/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8851 CONNER DR
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-5078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-585-2977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8851 CONNER DR
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-5078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-585-2977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ANA PAULA GOMES MAURO
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 714-585-2977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 15033
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------