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5700 Baltimore Dr Unit 216 La Mesa CA 91942-1643 | |
| (626) 502-6184 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5700 Baltimore Dr Unit 216, La Mesa, California |
| Authorized Official Name and Position | Jeffrey P Tang (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6265026184 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5700 Baltimore Dr Unit 216 La Mesa CA 91942-1643 Ph: (626) 502-6184 | 5700 Baltimore Dr Unit 216 La Mesa CA 91942-1643 Ph: (626) 502-6184 |
| NPI Number | 1588436596 |
|---|---|
| Provider Enumeration Date | 10/23/2023 |
| Last Update Date | 09/17/2024 |
| Certification Date | 09/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588436596 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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