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General NPI Number Information
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NPI Number | 1467968677
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Entity Type | Organization
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Legal Business Name | LIFE VESSEL TREATMENT AND RECOVERY
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 25466 GLORIOSA DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4642
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Country | US
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Telephone | 949-388-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 W 17TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-4503
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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 | EXECUTIVE DIRECTOR
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Name | CESAR B CABRERA
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Credential | PHARM D
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Telephone | 949-388-4114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | 300683AP
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License Number State | CA
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