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14931 Dale Evans Pkwy Apple Valley CA 92307-3061 | |
| (760) 240-7400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 14931 Dale Evans Pkwy, Apple Valley, California |
| Authorized Official Name and Position | Erica Porteous (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 9093880879 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
303 E Vanderbilt Way San Bernardino CA 92415-0026 Ph: (909) 388-0900 | 14931 Dale Evans Pkwy Apple Valley CA 92307-3061 Ph: (760) 240-7400 |
| NPI Number | 1891344115 |
|---|---|
| Provider Enumeration Date | 09/09/2019 |
| Last Update Date | 09/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891344115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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