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General NPI Number Information
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NPI Number | 1164184107
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Entity Type | Organization
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Legal Business Name | MALIBU DETOX, LLC.
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 7214 BIRDVIEW AVE
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City | MALIBU
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State | CA
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Zip | 90265-4111
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Country | US
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Telephone | 310-956-4692
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Fax |
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Provider Business Mailing Address
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Address Line | 22766 SADDLE PEAK RD
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City | TOPANGA
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State | CA
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Zip | 90290-3470
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Country | US
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Telephone | 310-956-4692
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBBY S STEMPLER
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Credential |
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Telephone | 310-595-5578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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