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655 Camino De Los Mares 120 San Clemente CA 92673-2809 | |
| (949) 487-1015 | |
| (949) 487-2840 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 655 Camino De Los Mares, San Clemente, California |
| Authorized Official Name and Position | Susan Mandel (PRESIDENT/CEO) |
| Authorized Official Contact | 6262545000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
800 S Santa Anita Ave Arcadia CA 91006-6853 Ph: (626) 254-5000 | 655 Camino De Los Mares 120 San Clemente CA 92673-2809 Ph: (949) 487-1015 |
| NPI Number | 1588814677 |
|---|---|
| Provider Enumeration Date | 09/24/2008 |
| Last Update Date | 09/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588814677 | NPI | - | NPPES |
| 30BV | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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