| Prototypes | |
|
831 E Arrow Hwy Pomona CA 91767-2535 | |
| (909) 624-1233 | |
| Not Available |
| Full Name | Prototypes |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 831 E Arrow Hwy, Pomona, California |
| Authorized Official Name and Position | Evanne Bree Jackson (SUD COUNSELOR II) |
| Authorized Official Contact | 9096241233 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prototypes 831 E Arrow Hwy Pomona CA 91767-2535 Ph: (909) 624-1233 | Prototypes 831 E Arrow Hwy Pomona CA 91767-2535 Ph: (909) 624-1233 |
| NPI Number | 1265069355 |
|---|---|
| Provider Enumeration Date | 03/26/2020 |
| Last Update Date | 03/27/2020 |
| Certification Date | 03/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265069355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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