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23228 Madero Mission Viejo CA 92691-2706 | |
| (949) 454-3940 | |
| (949) 770-1953 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 23228 Madero, Mission Viejo, 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 | 23228 Madero Mission Viejo CA 92691-2706 Ph: (949) 454-3940 |
| NPI Number | 1922145143 |
|---|---|
| Provider Enumeration Date | 01/30/2007 |
| Last Update Date | 12/20/2019 |
| Certification Date | 12/20/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922145143 | NPI | - | NPPES |
| 8082 | Medicaid | CA |
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