| Av Bridges Mental Health Corp | |
|
1331 W. Ave J Unit 101a Lancaster CA 93534 | |
| (661) 310-3110 | |
| (661) 310-3112 |
| Full Name | Av Bridges Mental Health Corp |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1331 W. Ave J, Lancaster, California |
| Authorized Official Name and Position | Vincent Estacio (RN/CEO) |
| Authorized Official Contact | 6613103110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Av Bridges Mental Health Corp 1331 W. Ave J Unit 101a Lancaster CA 93534 Ph: (661) 310-3110 | Av Bridges Mental Health Corp 1331 W. Ave J Unit 101a Lancaster CA 93534 Ph: (661) 310-3110 |
| NPI Number | 1114799178 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 05/13/2024 |
| Certification Date | 05/13/2024 |
| Medicare PECOS PAC ID | 5092157321 |
|---|---|
| Medicare Enrollment ID | O20240531001034 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114799178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Latha Madhavan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558490037 PECOS PAC ID: 3779809181 Enrollment ID: I20150303000016 |
| Provider Name | Vanessa Tabungar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760046924 PECOS PAC ID: 0345570396 Enrollment ID: I20190918001481 |
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