| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 875 Geer Rd, Turlock, California |
| Authorized Official Name and Position | David Xiong (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9165333428 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
875 Geer Rd Turlock CA 95380-3311 Ph: (209) 633-3057 | 875 Geer Rd Turlock CA 95380-3311 Ph: (209) 633-3057 |
| NPI Number | 1972159986 |
|---|---|
| Provider Enumeration Date | 08/15/2019 |
| Last Update Date | 01/27/2025 |
| Certification Date | 01/27/2025 |
| Medicare PECOS PAC ID | 9931393188 |
|---|---|
| Medicare Enrollment ID | O20101101001310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972159986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Cesar Velasquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336101153 PECOS PAC ID: 9931256385 Enrollment ID: I20090422000163 |
| Provider Name | Juan Manuel Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730658683 PECOS PAC ID: 3072927466 Enrollment ID: I20210202000497 |
| Provider Name | Manuel J Jimenez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891810958 PECOS PAC ID: 7315125721 Enrollment ID: I20240812002900 |
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