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780 W Olive Ave Ste 105 Merced CA 95348-2437 | |
(209) 354-4430 | |
(209) 354-4824 |
Full Name | |
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Speciality | Community/Behavioral Health |
Location | 780 W Olive Ave Ste 105, Merced, California |
Authorized Official Name and Position | Patricia Mendonca (VICE PRESIDENT) |
Authorized Official Contact | 2093544430 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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780 W Olive Ave Ste 105 Merced CA 95348-2437 Ph: (209) 354-4430 | 780 W Olive Ave Ste 105 Merced CA 95348-2437 Ph: (209) 354-4430 |
NPI Number | 1083370423 |
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Provider Enumeration Date | 11/10/2021 |
Last Update Date | 11/22/2024 |
Certification Date | 11/22/2024 |
Medicare PECOS PAC ID | 3678008943 |
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Medicare Enrollment ID | O20241122002564 |
Identifier | Type | State | Issuer |
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1083370423 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Provider Name | Diane A Jenkin |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1215613070 PECOS PAC ID: 1759816515 Enrollment ID: I20241203001837 |
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