| Avita Nova | |
|
1202 Bellecour Way Lake Forest CA 92630-7944 | |
| (949) 939-8032 | |
| (949) 525-4759 |
| Full Name | Avita Nova |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1202 Bellecour Way, Lake Forest, California |
| Authorized Official Name and Position | Erica R. Holding (OWNER) |
| Authorized Official Contact | 9499398032 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avita Nova 1202 Bellecour Way Lake Forest CA 92630-7944 Ph: (949) 939-8032 | Avita Nova 1202 Bellecour Way Lake Forest CA 92630-7944 Ph: (949) 939-8032 |
| NPI Number | 1780937235 |
|---|---|
| Provider Enumeration Date | 10/22/2012 |
| Last Update Date | 10/22/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780937235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 252Y00000X | Early Intervention Provider Agency | (* (Not Available)) | Secondary |
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