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General NPI Number Information
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NPI Number | 1306465224
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Entity Type | Organization
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Legal Business Name | BELLE JEUNESSE INC
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 600 CORPORATE DR STE 150
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City | LADERA RANCH
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State | CA
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Zip | 92694-2109
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Country | US
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Telephone | 949-347-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 600 CORPORATE DR STE 150
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City | LADERA RANCH
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State | CA
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Zip | 92694-2109
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Country | US
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Telephone | 949-347-1040
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MS. CANDYSSE CARLSEN
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Credential | R.N.
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Telephone | 323-992-5071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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