Individual
HORATIUS GITTENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MFTI
Contact information
Practice address
1053 N D ST, SAN BERNARDINO, CA 92410-3521
(909) 763-5500
Mailing address
1053 N D ST, SAN BERNARDINO, CA 92410-3521
(909) 763-5500
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00188
LEGAL ENTITY NUMBER
CA
Enumeration date
08/06/2013
Last updated
08/06/2013
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