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General NPI Number Information
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NPI Number | 1790288116
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Entity Type | Organization
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Legal Business Name | PMR IOP LLC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 2945 HARDING ST STE 213
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City | CARLSBAD
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State | CA
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Zip | 92008-1818
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Country | US
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Telephone | 951-662-5688
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Fax |
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Provider Business Mailing Address
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Address Line | 894 ANTILLA WAY
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City | SAN MARCOS
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State | CA
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Zip | 92078-0917
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Country | US
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Telephone | 951-662-5688
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | AMY GLADDEN
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Credential | CADCII, ICADC
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Telephone | 951-662-5688
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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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