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40015 Sierra Hwy Ste B280 Palmdale CA 93550-2143 | |
| (508) 740-6803 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 40015 Sierra Hwy Ste B280, Palmdale, California |
| Authorized Official Name and Position | Mary Patricia Rodenberg-roberts (VP & SR. ASST GENERAL COUNSEL) |
| Authorized Official Contact | 9528362234 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9166 Anaheim Pl Ste 200 Rancho Cucamonga CA 91730-8547 Ph: (909) 483-2505 | 40015 Sierra Hwy Ste B280 Palmdale CA 93550-2143 Ph: (508) 740-6803 |
| NPI Number | 1316311996 |
|---|---|
| Provider Enumeration Date | 11/19/2015 |
| Last Update Date | 05/07/2024 |
| Certification Date | 05/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316311996 | NPI | - | NPPES |
| 1316311996 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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