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General NPI Number Information
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NPI Number | 1649817842
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Entity Type | Organization
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Legal Business Name | THE SOCIAL WORK ACTION GROUP
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 28497 CALIFORNIA 74 SUITE 113
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City | LAKE ELSINORE
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State | CA
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Zip | 92532
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Country | US
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Telephone | 833-792-4674
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Fax | 951-609-2001
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Provider Business Mailing Address
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Address Line | 28497 CALIFORNIA 74 SUITE 113
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City | LAKE ELSINORE
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State | CA
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Zip | 92532
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Country | US
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Telephone | 833-792-4674
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Fax | 951-609-2001
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MRS. BETTY J VAN HORN
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Credential | NP
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Telephone | 909-234-2846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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