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General NPI Number Information
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NPI Number | 1154100113
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Entity Type | Individual
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Provider Name | ADAN AMBROSSI
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Gender | Male
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 104 W 4TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-3905
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Country | US
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Telephone | 909-382-9899
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 E COOLEY DR
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City | COLTON
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State | CA
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Zip | 92324-3905
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Country | US
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Telephone | 909-580-3758
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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