| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 17830 Arrow Blvd., Fontana, California |
| Authorized Official Name and Position | Erica Ochoa (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 9093880882 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
303 E Vanderbilt Way San Bernardino CA 92415-0026 Ph: (909) 388-0900 | 17830 Arrow Blvd. Fontana CA 92335 Ph: (909) 356-6452 |
| NPI Number | 1912258633 |
|---|---|
| Provider Enumeration Date | 09/20/2012 |
| Last Update Date | 09/07/2022 |
| Certification Date | 04/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912258633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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