| Pc Portals New Hampshire | |
|
679 S. New Hampshire Ave. Suite 400 Los Angeles CA 90005-1355 | |
| (626) 254-5000 | |
| Not Available |
| Full Name | Pc Portals New Hampshire |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 679 S. New Hampshire Ave., Los Angeles, 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 |
|---|---|
| Pc Portals New Hampshire 800 S Santa Anita Ave Arcadia CA 91006-3536 Ph: (626) 254-5000 | Pc Portals New Hampshire 679 S. New Hampshire Ave. Suite 400 Los Angeles CA 90005-1355 Ph: (626) 254-5000 |
| NPI Number | 1215064969 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 08/17/2021 |
| Certification Date | 08/17/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215064969 | NPI | - | NPPES |
| 19AN | Medicaid | CA | |
| 7678 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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