| Azusa Pacific University | |
|
918 E Alosta Ave Azusa CA 91702-2709 | |
| (626) 815-5421 | |
| Not Available |
| Full Name | Azusa Pacific University |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 918 E Alosta Ave, Azusa, California |
| Authorized Official Name and Position | Mark Dickerson (VICE PRESIDENT) |
| Authorized Official Contact | 6263875763 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Azusa Pacific University 901 E Alosta Ave Azusa CA 91702-2701 Ph: (626) 815-5421 | Azusa Pacific University 918 E Alosta Ave Azusa CA 91702-2709 Ph: (626) 815-5421 |
| NPI Number | 1104002146 |
|---|---|
| Provider Enumeration Date | 01/19/2008 |
| Last Update Date | 01/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104002146 | 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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