Organization
CALIFORNIA DIVERSION INTERVENTION FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARRY K. MIYAJI (PROGRAM DIRECTOR)
(714) 633-0502
Entity
Organization
Contact information
Practice address
1095 N MAIN ST, SUITE B, ORANGE, CA 92867-5476
(714) 633-0502
(714) 633-9249
Mailing address
1095 N MAIN ST, SUITE B, ORANGE, CA 92867-5476
(714) 633-0502
(714) 633-9249
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300125BN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300125BN
OUTPATIENT CERTIFICATION
CA
Enumeration date
10/12/2006
Last updated
07/15/2009
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