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General NPI Number Information
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NPI Number | 1891483855
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Entity Type | Individual
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Provider Name | MARCUS ANTONIO BEDFORD JR.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 221 E BARCLAY ST
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City | LONG BEACH
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State | CA
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Zip | 90805
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Country | US
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Telephone | 562-416-3254
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Fax | 562-860-4865
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | ARTESIA
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State | CA
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Zip | 90702-0010
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Country | US
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Telephone | 562-416-3254
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Fax | 562-860-4865
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | HRPSS003512
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License Number State | CA
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