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General NPI Number Information
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NPI Number | 1124815584
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Entity Type | Individual
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Provider Name | LISA HEATHER RABENSTEIN RADT
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Gender | Female
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 650 S INDIAN HILL BLVD
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City | CLAREMONT
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State | CA
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Zip | 91711-5444
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Country | US
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Telephone | 909-476-2023
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Fax |
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Provider Business Mailing Address
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Address Line | 3286 E GUASTI RD STE 100
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City | ONTARIO
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State | CA
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Zip | 91761-8646
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Country | US
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Telephone | 949-547-1794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R1607050425
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License Number State | CA
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