| Kaiser Permanente | |
|
12815 Heacock St Moreno Valley CA 92553-3116 | |
| (051) 601-6174 | |
| (951) 601-6224 |
| Full Name | Kaiser Permanente |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 12815 Heacock St, Moreno Valley, California |
| Authorized Official Name and Position | Roger Jackson Melton (COUNSELOR III) |
| Authorized Official Contact | 9516016171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kaiser Permanente 12815 Heacock St Moreno Valley CA 92553-3116 Ph: (051) 601-6174 | Kaiser Permanente 12815 Heacock St Moreno Valley CA 92553-3116 Ph: (051) 601-6174 |
| NPI Number | 1265639660 |
|---|---|
| Provider Enumeration Date | 06/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265639660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | MFC17474 (California) | Primary |
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