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General NPI Number Information
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NPI Number | 1508308503
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Entity Type | Organization
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Legal Business Name | SOCAL RECOVERY, INC
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 1351 LOGAN AVE UNIT C
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City | COSTA MESA
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State | CA
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Zip | 92626-4006
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Country | US
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Telephone | 949-463-9406
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Fax |
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Provider Business Mailing Address
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Address Line | 2973 HARBOR BLVD # 563
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City | COSTA MESA
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State | CA
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Zip | 92626-3912
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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 | DIRECTOR
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Name | IAN GRIMLEY
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Credential |
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Telephone | 949-463-9496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | CA
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