| Pacific Clinics Latina Youth Program | |
|
11741 Telegraph Rd Suite G Santa Fe Springs CA 90670-3681 | |
| (562) 942-8256 | |
| (562) 942-9789 |
| Full Name | Pacific Clinics Latina Youth Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11741 Telegraph Rd, Santa Fe Springs, California |
| Authorized Official Name and Position | James J. Balla (PRESIDENT & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6262545000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Clinics Latina Youth Program 800 S Santa Anita Ave Arcadia CA 91006-6853 Ph: (626) 254-5000 | Pacific Clinics Latina Youth Program 11741 Telegraph Rd Suite G Santa Fe Springs CA 90670-3681 Ph: (562) 942-8256 |
| NPI Number | 1225173180 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 09/23/2021 |
| Certification Date | 09/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225173180 | NPI | - | NPPES |
| 19AN | Medicaid | CA | |
| 7495 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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