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General NPI Number Information
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NPI Number | 1871864983
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Entity Type | Organization
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Legal Business Name | IXDM INC.
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 27301 WESTRIDGE LN.
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 949-349-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 33591 VIA DE AGUA
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675
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Country | US
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Telephone | 949-362-3699
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CATHERINE CAMERON PEARCE
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Credential |
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Telephone | 949-400-7317
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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 | 300216AP
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License Number State | CA
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