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General NPI Number Information
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NPI Number | 1497139539
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Entity Type | Organization
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Legal Business Name | BLUE PEARL PROJECT
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 23690 BUNDY CANYON RD
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City | WILDOMAR
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State | CA
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Zip | 92595-7588
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Country | US
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Telephone | 951-805-7419
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Fax |
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Provider Business Mailing Address
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Address Line | 23690 BUNDY CANYON RD
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City | WILDOMAR
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State | CA
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Zip | 92595-7588
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Country | US
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Telephone | 951-805-7419
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DEBBIE PHILLIPS
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Credential |
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Telephone | 951-805-7419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number |
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License Number State |
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