Provider Demographics
NPI:1053757666
Name:JUNIPER RIDGE DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, LLC
Entity type:Organization
Organization Name:JUNIPER RIDGE DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:P
Authorized Official - Last Name:COEHLO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-323-5515
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:62930 O B RILEY RD STE 300
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-9459
Practice Address - Country:US
Practice Address - Phone:541-323-5515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUNIPER RIDGE DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site