| |
16041 Kamana Rd Ste A Apple Valley CA 92307-1331 | |
(760) 552-9556 | |
Not Available |
Full Name | |
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Speciality | Social Worker |
Location | 16041 Kamana Rd Ste A, Apple Valley, California |
Authorized Official Name and Position | Myra Dina Lopez (OWNER/CEO) |
Authorized Official Contact | 7605529556 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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16041 Kamana Rd Ste A Apple Valley CA 92307-1331 Ph: (760) 552-9556 | 16041 Kamana Rd Ste A Apple Valley CA 92307-1331 Ph: (760) 552-9556 |
NPI Number | 1427712835 |
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Provider Enumeration Date | 10/22/2021 |
Last Update Date | 06/23/2022 |
Certification Date | 06/16/2022 |
Medicare PECOS PAC ID | 9335522598 |
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Medicare Enrollment ID | O20220821000120 |
Identifier | Type | State | Issuer |
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1427712835 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Myra Dina Lopez |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1023572583 PECOS PAC ID: 5193125706 Enrollment ID: I20210617002280 |
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