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15480 Ramona Ave Victorville CA 92392-2421 | |
| (760) 243-8145 | |
| (909) 388-0898 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 15480 Ramona Ave, Victorville, 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) 388-0801 | 15480 Ramona Ave Victorville CA 92392-2421 Ph: (760) 243-8145 |
| NPI Number | 1912259680 |
|---|---|
| Provider Enumeration Date | 10/05/2012 |
| Last Update Date | 09/07/2022 |
| Certification Date | 09/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912259680 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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