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1100 Quail Street Suite 205 Newport Beach CA 92660 | |
| (949) 979-6866 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1100 Quail Street, Newport Beach, California |
| Authorized Official Name and Position | Tahamtan Nematbakhsh (CEO) |
| Authorized Official Contact | 9493755541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1100 Quail St Ste 205 Newport Beach CA 92660-2700 Ph: (949) 979-6866 | 1100 Quail Street Suite 205 Newport Beach CA 92660 Ph: (949) 979-6866 |
| NPI Number | 1073142907 |
|---|---|
| Provider Enumeration Date | 04/03/2020 |
| Last Update Date | 07/21/2023 |
| Certification Date | 07/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073142907 | NPI | - | NPPES |
| 300428AP | Other | CA | DEPARTMENT OF HEALTH CARE SERVICES (DHCS) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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