Organization
BELLA VITA CHILDREN AND FAMILY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REGINA RAE SIEZ LCSW (CEO/DIRECTOR)
(951) 757-1528
Entity
Organization
Contact information
Practice address
31570 RAILROAD CANYON RD, SUITE 202, CANYON LAKE, CA 92587-9444
(951) 757-1528
Mailing address
31570 RAILROAD CANYON RD, SUITE 202, CANYON LAKE, CA 92587-9444
(951) 757-1528
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCS 25660
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
APPLIED FOR
—
CA
Enumeration date
06/11/2013
Last updated
06/11/2013
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