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NPI Code Detail

MEDICARE: MEBE COLORADO, LLC

MEDICARE: MEBE COLORADO, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist
2106E00000XAssistant Behavior Analyst
3106S00000XBehavior Technician
4225X00000XOccupational Therapist
5103K00000XBehavior Analyst

General Provider Information

NPI Number : 1346881984
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEBE COLORADO, LLC
Provider Business Mailing Address
First Line : 8885 RIO SAN DIEGO DR STE 340
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1669
Country : US
Telephone Number : 619-564-8647
Fax Number :
Provider Business Practice Location Address
First Line : 8310 S VALLEY HWY STE 300
Second Line :
City : ENGLEWOOD
State : CO
Zip : 80112-5815
Country : US
Telephone Number : 619-795-9925
Fax Number :
Authorized Official
Title or Position : CONTRACT AND CREDENTIALING
Name : MR. ESTEBAN GONZALEZ
Credential :
Telephone Number : 619-323-0832
Provider Enumeration Date : 10/04/2019
Last Update Date : 04/14/2021

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Directions to “MEBE COLORADO, LLC ” Practice Location

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