| Lemon Heights Holdings Inc. | |
|
17215 Studebaker Road Suite 110 Cerritos CA 90703-2521 | |
| (562) 860-2210 | |
| (562) 860-1154 |
| Full Name | Lemon Heights Holdings Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 17215 Studebaker Road, Cerritos, California |
| Authorized Official Name and Position | Robert Nils Johansen (OWNER-OFFICER) |
| Authorized Official Contact | 5628602210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lemon Heights Holdings Inc. Po Box 2089 Artesia CA 90702-2089 Ph: (562) 860-2210 | Lemon Heights Holdings Inc. 17215 Studebaker Road Suite 110 Cerritos CA 90703-2521 Ph: (562) 860-2210 |
| NPI Number | 1982945689 |
|---|---|
| Provider Enumeration Date | 03/06/2013 |
| Last Update Date | 03/06/2013 |
| Medicare PECOS PAC ID | 3375781339 |
|---|---|
| Medicare Enrollment ID | O20130603000377 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982945689 | NPI | - | NPPES |
| PSY101290 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY10129 (California) | Primary |
| Provider Name | Robert N Johansen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609860295 PECOS PAC ID: 3870653074 Enrollment ID: I20091021000105 |
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