| Providence Saint Johns Health Cid | |
|
1339 20th St Santa Monica CA 90404-2033 | |
| (310) 829-8921 | |
| (310) 829-8455 |
| Full Name | Providence Saint Johns Health Cid |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1339 20th St, Santa Monica, California |
| Authorized Official Name and Position | Ruth Canas (OUTPATIENT DIRECTOR) |
| Authorized Official Contact | 3108298921 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Saint Johns Health Cid 1339 20th St Santa Monica CA 90404-2033 Ph: (310) 829-8921 | Providence Saint Johns Health Cid 1339 20th St Santa Monica CA 90404-2033 Ph: (310) 829-8921 |
| NPI Number | 1184750168 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 04/21/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184750168 | NPI | - | NPPES |
| 000006792 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 569538 (California) | Primary |
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