| California Diversion Intervention Foundation | |
|
1095 N Main St Suite B Orange CA 92867-5476 | |
| (714) 633-0502 | |
| (714) 633-9249 |
| Full Name | California Diversion Intervention Foundation |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1095 N Main St, Orange, California |
| Authorized Official Name and Position | Harry K. Miyaji (PROGRAM DIRECTOR) |
| Authorized Official Contact | 7146330502 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| California Diversion Intervention Foundation 1095 N Main St Suite B Orange CA 92867-5476 Ph: (714) 633-0502 | California Diversion Intervention Foundation 1095 N Main St Suite B Orange CA 92867-5476 Ph: (714) 633-0502 |
| NPI Number | 1154410652 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 07/15/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154410652 | NPI | - | NPPES |
| 300125BN | Other | CA | OUTPATIENT CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 300125BN (California) | Primary |
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