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NPI Code Detail

MEDICARE: HOPE CANYON

MEDICARE: HOPE CANYON
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
12084P0800XPsychiatry Physician
2324500000XSubstance Abuse Rehabilitation FacilityCA

General Provider Information

NPI Number : 1992216063
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE CANYON
Provider Business Mailing Address
First Line : 1515 NW 167TH ST STE 300
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5106
Country : US
Telephone Number : 786-923-3376
Fax Number :
Provider Business Practice Location Address
First Line : 2821 LANGE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122-3109
Country : US
Telephone Number : 855-804-6503
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. ROBERT NIZNIK
Credential :
Telephone Number : 855-804-6503
Provider Enumeration Date : 10/17/2017
Last Update Date : 06/04/2020

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Directions to “HOPE CANYON ” Practice Location

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