| Jill R Diamond De Porras Licensed Marriage And Family Therapist, Inc. | |
|
27715 Jefferson Ave Ste 112 Temecula CA 92590-6601 | |
| (951) 288-6835 | |
| Not Available |
| Full Name | Jill R Diamond De Porras Licensed Marriage And Family Therapist, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 27715 Jefferson Ave Ste 112, Temecula, California |
| Authorized Official Name and Position | Jill Diamond De Porras (CEO) |
| Authorized Official Contact | 9512886835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jill R Diamond De Porras Licensed Marriage And Family Therapist, Inc. 27715 Jefferson Ave Ste 112 Temecula CA 92590-6601 Ph: () - | Jill R Diamond De Porras Licensed Marriage And Family Therapist, Inc. 27715 Jefferson Ave Ste 112 Temecula CA 92590-6601 Ph: (951) 288-6835 |
| NPI Number | 1538825914 |
|---|---|
| Provider Enumeration Date | 11/10/2021 |
| Last Update Date | 03/12/2024 |
| Certification Date | 03/12/2024 |
| Medicare PECOS PAC ID | 2365889250 |
|---|---|
| Medicare Enrollment ID | O20240327003241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538825914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jill Roxanne Diamond De Porras |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1811284391 PECOS PAC ID: 4183061070 Enrollment ID: I20240327003329 |
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