| Ab 109-sm | |
|
124 Carmen Ln Suite K Santa Maria CA 93458-7768 | |
| (805) 346-7620 | |
| (805) 346-7621 |
| Full Name | Ab 109-sm |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 124 Carmen Ln, Santa Maria, California |
| Authorized Official Name and Position | Tammy Casiano (QCM COORDINATOR/DESIGNEE) |
| Authorized Official Contact | 8053255905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ab 109-sm 315 Camino Del Remedio Suite 257 Santa Barbara CA 93110-1332 Ph: (805) 681-5220 | Ab 109-sm 124 Carmen Ln Suite K Santa Maria CA 93458-7768 Ph: (805) 346-7620 |
| NPI Number | 1467707331 |
|---|---|
| Provider Enumeration Date | 07/17/2012 |
| Last Update Date | 08/23/2021 |
| Certification Date | 08/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467707331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (California) | Primary |
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