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Organization
POSITIVE RECOVERY CENTER
Active
Organization
POSITIVE RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ANA M CORDOVA (MANAGER)
(714) 730-0505
Entity
Organization
Contact information
Practice address
17291 IRVINE BLVD STE 104, TUSTIN, CA 92780-2929
(714) 730-0505
(714) 730-0113
Mailing address
17291 IRVINE BLVD STE 104, TUSTIN, CA 92780-2929
(714) 730-0505
(714) 730-0113
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY6949
CA
103TH0100X
Health Service Psychologist
PSY6949
CA
106H00000X
Marriage & Family Therapist
PSY6949
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY6949
BLUE CROSS/BLUE SHIELD PPO
CA
Enumeration date
12/07/2011
Last updated
12/07/2011
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