Provider Demographics
NPI:1225342579
Name:NEGRETE, IVAN
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:NEGRETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31681 RIVERSIDE DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7815
Mailing Address - Country:US
Mailing Address - Phone:951-674-9243
Mailing Address - Fax:
Practice Address - Street 1:31681 RIVERSIDE DR
Practice Address - Street 2:SUITE L
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7815
Practice Address - Country:US
Practice Address - Phone:951-674-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor