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General NPI Number Information
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NPI Number | 1730981184
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Entity Type | Organization
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Legal Business Name | ALTA BEHAVIORAL AND WELLNESS MEDICAL GROUP INC.
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 2410 S AZUSA AVENUE
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City | WEST COVINA
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State | CA
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Zip | 91792-1512
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Country | US
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Telephone | 909-282-0794
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 S AZUSA AVENUE
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City | WEST COVINA
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State | CA
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Zip | 91792-1512
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Country | US
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Telephone | 909-282-0794
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. MARLON H. CARPIO
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Credential | FNP-C
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Telephone | 909-282-0794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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