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General NPI Number Information
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NPI Number | 1528632882
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Entity Type | Organization
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Legal Business Name | SCOTT-SOMMER SOBRIETY SYSTEMS
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1370 LOGAN AVE STE K
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City | COSTA MESA
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State | CA
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Zip | 92626-4024
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Country | US
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Telephone | 657-493-3007
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 LOGAN AVE STE K
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City | COSTA MESA
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State | CA
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Zip | 92626-4024
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Country | US
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Telephone | 657-493-3007
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | ETHAN SOMMER
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Credential |
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Telephone | 657-493-3007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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