Basic Information
Provider Information
NPI: 1740326602
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEGRETE
FirstName: BEATRIZ
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 S SANTA ANITA AVE
Address2:  
City: ARCADIA
State: CA
PostalCode: 910066853
CountryCode: US
TelephoneNumber: 6262545000
FaxNumber:  
Practice Location
Address1: 1717 W ORANGEWOOD AVE
Address2: SUITE I
City: ORANGE
State: CA
PostalCode: 928682040
CountryCode: US
TelephoneNumber: 7147128340
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/29/2007
LastUpdateDate: 02/04/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
374700000X  N Nursing Service Related ProvidersTechnician 
1041C0700X70438CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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