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13001 Ramona Blvd Ste E Irwindale CA 91706-3752 | |
| (626) 480-8107 | |
| (626) 869-0280 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 13001 Ramona Blvd Ste E, Irwindale, California |
| Authorized Official Name and Position | Cassandra Elaine Gibson-judkins (ASSISTANT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6264808107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13001 Ramona Blvd Ste E Irwindale CA 91706-3752 Ph: (626) 480-8107 | 13001 Ramona Blvd Ste E Irwindale CA 91706-3752 Ph: (626) 480-8107 |
| NPI Number | 1013455187 |
|---|---|
| Provider Enumeration Date | 02/08/2017 |
| Last Update Date | 04/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013455187 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
Renew Integrated Program #2 Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5200 Irwindale Ave Ste 210, Irwindale, CA 91706 Phone: 626-960-3964 | |