| Prototypes Obhs Wellness Center | |
|
40 N Altadena Dr Suite 1b Pasadena CA 91107-3386 | |
| (626) 792-2812 | |
| Not Available |
| Full Name | Prototypes Obhs Wellness Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 40 N Altadena Dr, Pasadena, California |
| Authorized Official Name and Position | Vitka Eisen (PRESIDENT AND CEO) |
| Authorized Official Contact | 2135423838 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prototypes Obhs Wellness Center 1563 Mission St Fl 4 San Francisco CA 94103-2543 Ph: () - | Prototypes Obhs Wellness Center 40 N Altadena Dr Suite 1b Pasadena CA 91107-3386 Ph: (626) 792-2812 |
| NPI Number | 1659822468 |
|---|---|
| Provider Enumeration Date | 10/17/2016 |
| Last Update Date | 08/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659822468 | NPI | - | NPPES |
| EO633A | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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