| Monte Nido Lake Vista, Llc | |
|
17059 El Cajon Ave Yorba Linda CA 92886-2220 | |
| (657) 363-4633 | |
| (714) 961-6052 |
| Full Name | Monte Nido Lake Vista, Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 17059 El Cajon Ave, Yorba Linda, California |
| Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3056631876 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Monte Nido Lake Vista, Llc 6100 Sw 76th St South Miami FL 33143-5002 Ph: (305) 663-1876 | Monte Nido Lake Vista, Llc 17059 El Cajon Ave Yorba Linda CA 92886-2220 Ph: (657) 363-4633 |
| NPI Number | 1609501279 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 07/19/2022 |
| Certification Date | 07/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609501279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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