| Magnolia Psychological Assessment & Therapy Center, Pc | |
|
12021 Jacaranda Ave Ste 201e Hesperia CA 92345-4978 | |
| (760) 454-6817 | |
| Not Available |
| Full Name | Magnolia Psychological Assessment & Therapy Center, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 12021 Jacaranda Ave Ste 201e, Hesperia, California |
| Authorized Official Name and Position | Rita Ogunlana (OWNER) |
| Authorized Official Contact | 7604546817 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Psychological Assessment & Therapy Center, Pc 12021 Jacaranda Ave Ste 201e Hesperia CA 92345-4978 Ph: (760) 454-6817 | Magnolia Psychological Assessment & Therapy Center, Pc 12021 Jacaranda Ave Ste 201e Hesperia CA 92345-4978 Ph: (760) 454-6817 |
| NPI Number | 1043057177 |
|---|---|
| Provider Enumeration Date | 07/15/2024 |
| Last Update Date | 07/15/2024 |
| Certification Date | 07/15/2024 |
| Medicare PECOS PAC ID | 8224569082 |
|---|---|
| Medicare Enrollment ID | O20241003002001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043057177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rita A Ogunlana |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730752395 PECOS PAC ID: 3577006097 Enrollment ID: I20240625000852 |
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