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1501 Magnolia Ave San Bruno CA 94066-5451 | |
| (650) 558-2778 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1501 Magnolia Ave, San Bruno, California |
| Authorized Official Name and Position | Jei Africa (DIRECTOR) |
| Authorized Official Contact | 6506132155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1501 Magnolia Ave San Bruno CA 94066-5451 Ph: () - | 1501 Magnolia Ave San Bruno CA 94066-5451 Ph: (650) 558-2778 |
| NPI Number | 1063939171 |
|---|---|
| Provider Enumeration Date | 08/29/2017 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063939171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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