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2035 E Ball Rd Suite 100 & 200 Anaheim CA 92806-5157 | |
| (714) 517-6300 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2035 E Ball Rd, Anaheim, California |
| Authorized Official Name and Position | Chi Y Rajalingam (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 7148343154 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
405 W 5th St Ste 212 Santa Ana CA 92701-4522 Ph: (714) 568-5614 | 2035 E Ball Rd Suite 100 & 200 Anaheim CA 92806-5157 Ph: (714) 517-6300 |
| NPI Number | 1245377423 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 09/03/2021 |
| Certification Date | 09/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245377423 | NPI | - | NPPES |
| 8001 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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