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919 1st St San Fernando CA 91340-2957 | |
| (818) 832-2400 | |
| (818) 832-2567 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 919 1st St, San Fernando, California |
| Authorized Official Name and Position | Lisa H. Wong (ACTING DIRECTOR) |
| Authorized Official Contact | 2137384601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | 919 1st St San Fernando CA 91340-2957 Ph: (818) 832-2400 |
| NPI Number | 1194207795 |
|---|---|
| Provider Enumeration Date | 08/30/2018 |
| Last Update Date | 09/09/2022 |
| Certification Date | 09/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194207795 | NPI | - | NPPES |
| 19AV | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Alejandro Soria, Licensed Marriage And Family Therapist Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 N Maclay Ave Ste 108, San Fernando, CA 91340 Phone: 323-251-1509 | |
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