| |
135 E 3rd Ave Ste. B Escondido CA 92025-4252 | |
(760) 705-8468 | |
(760) 735-2922 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 135 E 3rd Ave, Escondido, California |
Authorized Official Name and Position | Holly Hastings Gines (OWNER/PRESIDENT) |
Authorized Official Contact | 8582124454 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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105 N Rose St Ste. 211 Escondido CA 92027-7222 Ph: (760) 705-8468 | 135 E 3rd Ave Ste. B Escondido CA 92025-4252 Ph: (760) 705-8468 |
NPI Number | 1821326158 |
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Provider Enumeration Date | 11/24/2009 |
Last Update Date | 02/02/2011 |
Identifier | Type | State | Issuer |
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1821326158 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | LCS 20560 (California) | Primary |
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