| Jack Gaines A Professional Corp. | |
|
4833 Rubio Ave Encino CA 91436-1118 | |
| (818) 981-4030 | |
| Not Available |
| Full Name | Jack Gaines A Professional Corp. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4833 Rubio Ave, Encino, California |
| Authorized Official Name and Position | Jack W. Gaines (PRESIDENT) |
| Authorized Official Contact | 8189814030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Gaines A Professional Corp. 4833 Rubio Ave Encino CA 91436-1118 Ph: () - | Jack Gaines A Professional Corp. 4833 Rubio Ave Encino CA 91436-1118 Ph: (818) 981-4030 |
| NPI Number | 1619210291 |
|---|---|
| Provider Enumeration Date | 04/01/2013 |
| Last Update Date | 04/01/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619210291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | C14269 (California) | Primary |
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