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General NPI Number Information
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NPI Number | 1558710251
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Entity Type | Organization
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Legal Business Name | B & G MEDICAL SERVICES
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 4000 BIRCH ST STE 112B
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2211
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Country | US
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Telephone | 949-422-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 BIRCH ST STE 112B
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2211
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Country | US
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Telephone | 949-422-4747
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | DEBORAH CASTO
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Credential |
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Telephone | 949-612-2712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 300293AP
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License Number State | CA
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