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780 E Gilbert St San Bernardino CA 92415 | |
| (909) 387-7194 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 780 E Gilbert St, San Bernardino, California |
| Authorized Official Name and Position | Erica Ochoa (CHIEF COMPLIANCE OFFICER) |
| Authorized Official Contact | 9093880882 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
303 E Vanderbilt Way San Bernardino CA 92415-0026 Ph: (909) 388-0801 | 780 E Gilbert St San Bernardino CA 92415 Ph: (909) 387-7194 |
| NPI Number | 1467658187 |
|---|---|
| Provider Enumeration Date | 06/21/2007 |
| Last Update Date | 09/07/2022 |
| Certification Date | 09/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467658187 | NPI | - | NPPES |
| 36DD | Other | CA | MEDI-CAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | ZZZ74743Z (California) | Primary |
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