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General NPI Number Information
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NPI Number | 1386783710
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Entity Type | Organization
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Legal Business Name | ONE 2 ONE MENTORS, INC.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16245 DESERT KNOLL DR
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City | VICTORVILLE
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State | CA
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Zip | 92395-4011
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Country | US
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Telephone | 760-245-1997
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1461
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City | VICTORVILLE
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State | CA
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Zip | 92393-1461
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KENNETH ROSE
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Credential |
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Telephone | 760-245-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 360059AN
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License Number State | CA
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