| Pavillion Healthcare Services | |
|
20930 Bonita St Suite Y Carson CA 90746-3680 | |
| (310) 532-3464 | |
| Not Available |
| Full Name | Pavillion Healthcare Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 20930 Bonita St, Carson, California |
| Authorized Official Name and Position | Martin Okon (PROGRAM DIRECTOR) |
| Authorized Official Contact | 3105323464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pavillion Healthcare Services 20930 Bonita St Suite Y Carson CA 90746-3680 Ph: (310) 532-3464 | Pavillion Healthcare Services 20930 Bonita St Suite Y Carson CA 90746-3680 Ph: (310) 532-3464 |
| NPI Number | 1124163100 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124163100 | NPI | - | NPPES |
| 7163 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 59793A (California) | Primary |
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