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38350 40th St E Palmdale CA 93552-3075 | |
| (213) 639-6306 | |
| (213) 381-5497 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 38350 40th St E, Palmdale, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | 38350 40th St E Palmdale CA 93552-3075 Ph: (213) 639-6306 |
| NPI Number | 1558803593 |
|---|---|
| Provider Enumeration Date | 11/08/2016 |
| Last Update Date | 08/30/2022 |
| Certification Date | 08/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558803593 | NPI | - | NPPES |
| 7998 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (California) | Primary |
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