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General NPI Number Information
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NPI Number | 1972807402
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Entity Type | Organization
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Legal Business Name | BELLA LA VITA COMPANY
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Dates
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Enumeration Date | 12/23/2010
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Last Update Date | 12/23/2010
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Provider Practice Location Address
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Address Line | 22516 CARBON MESA RD
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City | MALIBU
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State | CA
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Zip | 90265-5019
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Country | US
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Telephone | 310-456-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 22516 CARBON MESA RD
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City | MALIBU
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State | CA
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Zip | 90265-5019
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Country | US
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Telephone | 310-456-2551
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Fax |
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Authorized Official
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Title or Position | CLAIMS ADMINISTRATOR
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Name | DR. PEGGY J LOCKE
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Credential | D.C.
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Telephone | 805-648-2570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190688AP
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License Number State | CA
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