| San Fernando Mhs -- Fsp Program | |
|
10605 Balboa Blvd Ste 100 Granada Hills CA 91344-6367 | |
| (818) 832-2400 | |
| (818) 832-2567 |
| Full Name | San Fernando Mhs -- Fsp Program |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 10605 Balboa Blvd Ste 100, Granada Hills, 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 |
|---|---|
| San Fernando Mhs -- Fsp Program 510 S Vermont Ave Los Angeles CA 90020-1992 Ph: (213) 738-4601 | San Fernando Mhs -- Fsp Program 10605 Balboa Blvd Ste 100 Granada Hills CA 91344-6367 Ph: (818) 832-2400 |
| NPI Number | 1699802488 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 09/23/2022 |
| Certification Date | 09/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699802488 | NPI | - | NPPES |
| 7651 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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