Basic Information
Provider Information | |||||||||
NPI: | 1821395260 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SEASONS RECOVERY PHYSICIANS GROUP, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 30245 PACIFIC COAST HWY | ||||||||
Address2: |   | ||||||||
City: | MALIBU | ||||||||
State: | CA | ||||||||
PostalCode: | 902653603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8009900340 | ||||||||
FaxNumber: | 9543370364 | ||||||||
Practice Location | |||||||||
Address1: | 30344 MORNING VIEW DR | ||||||||
Address2: |   | ||||||||
City: | MALIBU | ||||||||
State: | CA | ||||||||
PostalCode: | 902653619 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8009900340 | ||||||||
FaxNumber: | 9543370364 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/22/2011 | ||||||||
LastUpdateDate: | 04/29/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
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ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZAYAS | ||||||||
AuthorizedOfficialFirstName: | JENNY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | ACCOUNT MANAGER | ||||||||
AuthorizedOfficialTelephone: | 8009900340 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 207Q00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   | 207QA0401X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 171100000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Acupuncturist |   | 2084P0800X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 207R00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   | 1041C0700X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TP2701X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.