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General NPI Number Information
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NPI Number | 1124767611
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Entity Type | Organization
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Legal Business Name | PARADIGM MALIBU CAVALLERI
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 6316 CAVALLERI RD
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City | MALIBU
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State | CA
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Zip | 90265-4018
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Country | US
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Telephone | 424-666-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 12424 WILSHIRE BLVD STE 800
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City | LOS ANGELES
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State | CA
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Zip | 90025-1035
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Country | US
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Telephone | 310-457-9008
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DUSTIN WAGNER
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Credential |
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Telephone | 310-457-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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