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General NPI Number Information
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NPI Number | 1386130961
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Entity Type | Organization
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Legal Business Name | RENEW BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 1431 ENCHANTE WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-5675
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Country | US
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Telephone | 949-813-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 1431 ENCHANTE WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-5675
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Country | US
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Telephone | 949-813-5161
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/PARTNER
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Name | MR. JOHN HERNANDEZ
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Credential | LMFT CALIFORNIA
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Telephone | 949-813-5161
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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 | 001372496
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License Number State | MO
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