Provider Demographics
NPI:1447279476
Name:SUN VALLEY BEHAVIORAL MEDICAL CENTER INC
Entity type:Organization
Organization Name:SUN VALLEY BEHAVIORAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-355-0161
Mailing Address - Street 1:2417 MARSHALL AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-355-0161
Mailing Address - Fax:760-355-2596
Practice Address - Street 1:2417 MARSHALL AVE
Practice Address - Street 2:STE 1
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251
Practice Address - Country:US
Practice Address - Phone:760-355-0161
Practice Address - Fax:760-355-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14634Medicare ID - Type Unspecified