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21101 Dale Evans Pkwy Apple Valley CA 92307-9356 | |
| (760) 961-6720 | |
| (760) 961-6788 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 21101 Dale Evans Pkwy, Apple Valley, California |
| Authorized Official Name and Position | Erica Ochoa (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 9093880882 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
303 E Vanderbilt Way San Bernardino CA 92415-0001 Ph: (909) 388-0801 | 21101 Dale Evans Pkwy Apple Valley CA 92307-9356 Ph: (760) 961-6720 |
| NPI Number | 1043428915 |
|---|---|
| Provider Enumeration Date | 05/21/2007 |
| Last Update Date | 05/09/2023 |
| Certification Date | 05/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043428915 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | ZZZ74743Z (California) | Primary |
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