| Amhs Tao South Fsp | |
|
275 East Baker Street, Suite A Costa Mesa CA 92626-4566 | |
| (714) 361-6760 | |
| (714) 361-6768 |
| Full Name | Amhs Tao South Fsp |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 275 East Baker Street,, Costa Mesa, California |
| Authorized Official Name and Position | Lorena Lopez (PROVIDER RELATIONS SUPERVISOR) |
| Authorized Official Contact | 5103377950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amhs Tao South Fsp 1080 Marina Village Pkwy Suite 100 Alameda CA 94501-6427 Ph: (510) 337-7950 | Amhs Tao South Fsp 275 East Baker Street, Suite A Costa Mesa CA 92626-4566 Ph: (714) 361-6760 |
| NPI Number | 1548512635 |
|---|---|
| Provider Enumeration Date | 10/12/2012 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548512635 | NPI | - | NPPES |
| CR722M | Other | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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