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General NPI Number Information
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NPI Number | 1376952515
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Entity Type | Organization
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Legal Business Name | PORTIA BELL HUME BEHAVIORAL HEALTH AND TRAINING CENTER
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 39420 LIBERTY ST SUITE 140
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City | FREMONT
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State | CA
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Zip | 94538-2200
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Country | US
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Telephone | 510-745-9151
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Fax |
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Provider Business Mailing Address
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Address Line | 39420 LIBERTY ST SUITE 140
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City | FREMONT
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State | CA
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Zip | 94538-2200
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Country | US
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Telephone | 510-745-9151
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATAIVE MANAGER
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Name | DR. FAWADA MOJADDIDI
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Credential | PSYD
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Telephone | 510-745-9151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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