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NPI Code Detail

MEDICARE: AURORA LIBBEY

MEDICARE: AURORA LIBBEY
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
11041C0700XClinical Social Worker
2101YM0800XMental Health CounselorASW94572CA

General Provider Information

NPI Number : 1801311899
Entity Type Code : Individual
Provider Name (Legal Business Name) : AURORA LIBBEY
Provider Business Mailing Address
First Line : 14677 MERRILL AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-4219
Country : US
Telephone Number : 951-643-2340
Fax Number :
Provider Business Practice Location Address
First Line : 14677 MERRILL AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-4219
Country : US
Telephone Number : 951-643-2340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 08/18/2021

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Directions to “ AURORA LIBBEY ” Practice Location

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