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81557 Doctor Carreon Blvd. Suite C-8 And C-9 Indio CA 92201-5562 | |
| (760) 391-6999 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 81557 Doctor Carreon Blvd., Indio, California |
| Authorized Official Name and Position | Kent Dunlap (PRESIDENT AND CHIEF EXECUTIVE OFFIC) |
| Authorized Official Contact | 3102216336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
81557 Doctor Carreon Blvd. Suite C-8 And C-9 Indio CA 92201-5562 Ph: (760) 391-6999 | 81557 Doctor Carreon Blvd. Suite C-8 And C-9 Indio CA 92201-5562 Ph: (760) 391-6999 |
| NPI Number | 1780861500 |
|---|---|
| Provider Enumeration Date | 01/23/2008 |
| Last Update Date | 03/26/2018 |
| Medicare PECOS PAC ID | 4082026117 |
|---|---|
| Medicare Enrollment ID | O20201215001615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780861500 | NPI | - | NPPES |
| 09-00009098 | Other | CA | CITY OF INDIO BIZ LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Roberto R. Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457361230 PECOS PAC ID: 4981024494 Enrollment ID: I20201022002373 |
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