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3551 Camino Mira Costa Suite T San Clemente CA 92672 | |
| (949) 272-4444 | |
| (949) 272-4445 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3551 Camino Mira Costa, San Clemente, California |
| Authorized Official Name and Position | Elaine Orourke (OPERATIONS MANAGER) |
| Authorized Official Contact | 7149534455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
525 Cabrillo Park Dr Ste 300 Santa Ana CA 92701-5017 Ph: (714) 953-4455 | 3551 Camino Mira Costa Suite T San Clemente CA 92672 Ph: (949) 272-4444 |
| NPI Number | 1821583337 |
|---|---|
| Provider Enumeration Date | 06/27/2018 |
| Last Update Date | 02/23/2023 |
| Certification Date | 02/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821583337 | NPI | - | NPPES |
| 910-1912-5 | Other | CA | STATE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 910-1912-5 (California) | Primary |
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