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Organization
MEBE TENNESSEE
Active
Organization
MEBE TENNESSEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESTEBAN GONZALEZ (CONTRACTS AND CREDENTIALING SPECIAL)
(619) 323-0832
Entity
Organization
Contact information
Practice address
6339 CHARLOTTE PIKE # 1035, NASHVILLE, TN 37209-2926
(619) 795-9925
Mailing address
8885 RIO SAN DIEGO DR STE 340, SAN DIEGO, CA 92108-1669
(619) 795-9925
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
208000000X
Pediatrics Physician
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
10/14/2020
Last updated
10/15/2020
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