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1440 E Broadway Glendale CA 91205-1503 | |
| (818) 242-3161 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1440 E Broadway, Glendale, California |
| Authorized Official Name and Position | Dulce M Ruiz (CONTRACTS AND GRANTS MANAGER) |
| Authorized Official Contact | 3107515442 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4760 Sepulveda Blvd Culver City CA 90230-4820 Ph: (310) 390-6612 | 1440 E Broadway Glendale CA 91205-1503 Ph: (818) 242-3161 |
| NPI Number | 1740875962 |
|---|---|
| Provider Enumeration Date | 03/09/2021 |
| Last Update Date | 03/09/2021 |
| Certification Date | 03/09/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740875962 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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