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General NPI Number Information
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NPI Number | 1992216063
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Entity Type | Organization
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Legal Business Name | HOPE CANYON
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 2821 LANGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92122-3109
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Country | US
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Telephone | 855-804-6503
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 NW 167TH ST STE 300
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5106
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Country | US
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Telephone | 786-923-3376
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT NIZNIK
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Credential |
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Telephone | 855-804-6503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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