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790 S State St Ste 6 San Jacinto CA 92583-4924 | |
| (951) 654-6002 | |
| (951) 658-7140 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 790 S State St Ste 6, San Jacinto, 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 |
|---|---|
790 S State St Ste 6 San Jacinto CA 92583-4924 Ph: (951) 654-6002 | 790 S State St Ste 6 San Jacinto CA 92583-4924 Ph: (951) 654-6002 |
| NPI Number | 1336896505 |
|---|---|
| Provider Enumeration Date | 03/07/2022 |
| Last Update Date | 05/07/2024 |
| Certification Date | 05/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336896505 | NPI | - | NPPES |
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