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General NPI Number Information
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NPI Number | 1548404353
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Entity Type | Organization
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Legal Business Name | MM UNLIMITED LLC
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 3811 FLORIN RD STE 12
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City | SACRAMENTO
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State | CA
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Zip | 95823-1803
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Country | US
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Telephone | 916-370-5505
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Fax | 916-429-6341
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Provider Business Mailing Address
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Address Line | 3811 FLORIN RD STE 12
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City | SACRAMENTO
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State | CA
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Zip | 95823-1803
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Country | US
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Telephone | 916-370-5505
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Fax | 916-429-6341
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Authorized Official
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Title or Position | CEO
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Name | MR. DENNIS EUGENE SLIDER
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Credential |
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Telephone | 916-429-6341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | A67184
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License Number State | CA
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