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3160 W Ramsey St Banning CA 92220-3724 | |
| (951) 267-3522 | |
| (951) 468-3087 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3160 W Ramsey St, Banning, California |
| Authorized Official Name and Position | Phillip Parra (PRESIDENT) |
| Authorized Official Contact | 9513187798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3160 W Ramsey St Banning CA 92220-3724 Ph: (512) 673-5229 | 3160 W Ramsey St Banning CA 92220-3724 Ph: (951) 267-3522 |
| NPI Number | 1760110530 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 1951842343 |
|---|---|
| Medicare Enrollment ID | O20240925003408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760110530 | NPI | - | NPPES |
| CA232096 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Phillip Parra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063688430 PECOS PAC ID: 5294016952 Enrollment ID: I20170111003092 |
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