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General NPI Number Information
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NPI Number | 1598454431
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Entity Type | Organization
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Legal Business Name | 1000 NEWBURY ROAD LLC
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Dates
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Enumeration Date | 05/05/2023
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 1000 NEWBURY RD STE 205
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6441
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Country | US
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Telephone | 562-207-8820
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 NEWBURY RD STE 205
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6441
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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 | MANAGER
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Name | HAJAR MOUSSAOUI
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Credential |
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Telephone | 562-207-8820
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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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