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General NPI Number Information
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NPI Number | 1316125081
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Entity Type | Organization
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Legal Business Name | AUBREY KING ,MD INC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 545 N MOUNTAIN AVE 201
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City | UPLAND
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State | CA
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Zip | 91786-5073
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Country | US
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Telephone | 909-946-0707
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Fax | 909-946-1946
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Provider Business Mailing Address
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Address Line | 545 N MOUNTAIN AVE 201
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City | UPLAND
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State | CA
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Zip | 91786-5073
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Country | US
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Telephone | 909-946-0707
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Fax | 909-946-1946
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Authorized Official
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Title or Position | CFO/ MEDICAL DIRECTOR
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Name | DR. AUBREY ANCIL KING
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Credential | M.D.
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Telephone | 909-946-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | G56023
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | G56023
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License Number State | CA
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