Provider Demographics
NPI:1124560479
Name:DEPARTMENT OF BEHAVIOR HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT OF BEHAVIOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER AND FAMILY ADVOCATE II
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-421-9495
Mailing Address - Street 1:418 E MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3624
Mailing Address - Country:US
Mailing Address - Phone:909-421-9495
Mailing Address - Fax:
Practice Address - Street 1:418 E MARIPOSA DR
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3624
Practice Address - Country:US
Practice Address - Phone:909-421-9495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health