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18780 Amar Rd Suite 204 Walnut CA 91789-4560 | |
| (626) 965-4463 | |
| (626) 965-9240 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 18780 Amar Rd, Walnut, California |
| Authorized Official Name and Position | Maria De Lourdes Caracoza (PRESIDENT/CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3235264016 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
900 Corporate Center Dr Ste 350 Monterey Park CA 91754-7620 Ph: (323) 526-4016 | 18780 Amar Rd Suite 204 Walnut CA 91789-4560 Ph: (626) 965-4463 |
| NPI Number | 1255465274 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 02/24/2020 |
| Certification Date | 02/24/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255465274 | NPI | - | NPPES |
| 7019 | Other | CA | MEDI-CAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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