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Organization
SCINTADEL LIBERTY, INC.
Active
Organization
SCINTADEL LIBERTY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY CHANDRAN (CEO)
(213) 422-6853
Entity
Organization
Contact information
Practice address
6833 INDIANA AVE STE 208, RIVERSIDE, CA 92506-4223
(213) 422-6853
Mailing address
921 N MILLIKEN AVE # 1176, ONTARIO, CA 91764-5083
(213) 422-6853
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/09/2023
Last updated
04/26/2023
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