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12039 Hertz Street Moorpark CA 93021 | |
| (805) 482-1265 | |
| (805) 389-5295 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12039 Hertz Street, Moorpark, California |
| Authorized Official Name and Position | Virginia M. Connell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8054821265 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
450 Rosewood Ave Camarillo CA 93010-5914 Ph: (805) 485-1265 | 12039 Hertz Street Moorpark CA 93021 Ph: (805) 482-1265 |
| NPI Number | 1790081966 |
|---|---|
| Provider Enumeration Date | 02/04/2011 |
| Last Update Date | 02/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790081966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 560015BN (California) | Primary |
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