Organization
BUENA PARK REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAM GOLDBERG (MANAGER)
(310) 343-8684
Entity
Organization
Contact information
Practice address
515 W COMMONWEALTH AVE STE 215, FULLERTON, CA 92832-1752
(310) 343-8684
Mailing address
515 W COMMONWEALTH AVE STE 215, FULLERTON, CA 92832-1752
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/05/2023
Last updated
11/01/2023
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