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General NPI Number Information
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NPI Number | 1275038879
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Entity Type | Organization
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Legal Business Name | SUN PREVENTION TREATMENT & RECOVERY LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2017 N BRIDGE ST
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City | VISALIA
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State | CA
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Zip | 93291-2174
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Country | US
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Telephone | 510-691-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 4023 W DOUGLAS AVE
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City | VISALIA
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State | CA
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Zip | 93291-4185
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Country | US
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Telephone | 510-691-0474
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK A GONZALES
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Credential | MS, LAADC-CA
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Telephone | 510-691-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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