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13001 Ramona Blvd Suite A. Irwindale CA 91706-3752 | |
(626) 373-2900 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Adolescent And Children Mental Health |
Location | 13001 Ramona Blvd, Irwindale, California |
Authorized Official Name and Position | Stacey Roth (CEO) |
Authorized Official Contact | 3232542274 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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13001 Ramona Blvd Suite A. Irwindale CA 91706-3752 Ph: (626) 373-2900 | 13001 Ramona Blvd Suite A. Irwindale CA 91706-3752 Ph: (626) 373-2900 |
NPI Number | 1700126687 |
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Provider Enumeration Date | 02/28/2013 |
Last Update Date | 01/05/2021 |
Certification Date | 01/05/2021 |
Identifier | Type | State | Issuer |
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1700126687 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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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 | |