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3102 E Highland Ave Patton CA 92369-7813 | |
(909) 425-7552 | |
(909) 425-6407 |
Full Name | |
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Speciality | Psychiatric Hospital |
Location | 3102 E Highland Ave, Patton, California |
Authorized Official Name and Position | Guadalupe M Alonzo-diaz (ADMINISTRATIVE DEPUTY DIRECTOR) |
Authorized Official Contact | 9166542655 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1215 O Street, Ms-3 Patient Cost Recovery Section Sacramento CA 95814-6414 Ph: (916) 651-8811 | 3102 E Highland Ave Patton CA 92369-7813 Ph: (909) 425-7552 |
NPI Number | 1043249204 |
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Provider Enumeration Date | 07/01/2006 |
Last Update Date | 06/28/2021 |
Certification Date | 06/07/2021 |
Medicare PECOS PAC ID | 9638174238 |
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Medicare Enrollment ID | O20090129000379 |
Identifier | Type | State | Issuer |
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1043249204 | NPI | - | NPPES |