Provider Demographics
NPI:1700362118
Name:MINDFUL BEHAVIORAL OUTPATIENT DISCOVERING YOUR SELF
Entity Type:Organization
Organization Name:MINDFUL BEHAVIORAL OUTPATIENT DISCOVERING YOUR SELF
Other - Org Name:MINDFUL REJUVENATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-870-6734
Mailing Address - Street 1:717 PIER VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2801
Mailing Address - Country:US
Mailing Address - Phone:951-870-6734
Mailing Address - Fax:760-692-2782
Practice Address - Street 1:717 PIER VIEW WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2801
Practice Address - Country:US
Practice Address - Phone:951-870-6734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health