SOCAL BEHAVIORAL MEDICINE INC. NPI 1134691124

NPI Information

  • NPI: 1134691124
  • Provider Name: SOCAL BEHAVIORAL MEDICINE, INC.
  • Classification: Internal Medicine - 207RA0401X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Doing Business As: SOCAL BEHAVIORAL MEDICINE
  • CLIA Number: 05D2177314
  • Address: 1711 VIA EL PRADO STE 301
    REDONDO BEACH, CA
    ZIP 90277
  • Phone: (310) 698-5252

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NPI Details

SOCAL BEHAVIORAL MEDICINE, INC. is an addiction medicine internal medicine in Redondo Beach, CA. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. SOCAL BEHAVIORAL MEDICINE, INC. NPI is 1134691124. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Socal Behavioral Medicine.

The provider's business location address is:

1711 VIA EL PRADO STE 301
REDONDO BEACH, CA
ZIP 90277-723
Phone: (310) 698-5252

The provider's authorized official is Ginger Hulst .
The authorized official title is Co-owner and has the following contact phone number (310) 698-5252.

The CLIA number assigned to this NPI record is 05D2177314 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/1/2019 and was last updated on 4/1/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163WP0000XRegistered NursePain ManagementNo
2163WP0809XRegistered NursePsychiatric/Mental Health, AdultNo
3207RA0401XInternal MedicineAddiction MedicineYes
4363LF0000XNurse PractitionerFamilyNo

What is NPI?

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This page was last updated on: 11/21/2025

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