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General NPI Number Information
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NPI Number | 1295042752
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Entity Type | Organization
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Legal Business Name | BETHANY'S GAIT INC.
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Dates
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Enumeration Date | 09/06/2010
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 27252 CALLE ARROYO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2745
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Country | US
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Telephone | 714-318-3498
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Fax |
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Provider Business Mailing Address
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Address Line | 27762 ANTONIO PKWY # L1-464
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City | LADERA RANCH
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State | CA
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Zip | 92694-1140
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Country | US
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Telephone | 714-318-3498
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CRISTI SILVERBERG-ROSE
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Credential |
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Telephone | 714-318-3498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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