| San Gabriel Children's Center Outpatient | |
|
4740 N Grand Ave Covina CA 91724-2005 | |
| (626) 859-2089 | |
| (626) 859-6537 |
| Full Name | San Gabriel Children's Center Outpatient |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4740 N Grand Ave, Covina, California |
| Authorized Official Name and Position | Porfirio Rincon (PRESIDENT/CEO) |
| Authorized Official Contact | 6268592089 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Gabriel Children's Center Outpatient 1211 Center Court Dr Ste 105 Covina CA 91724-3613 Ph: (626) 859-2089 | San Gabriel Children's Center Outpatient 4740 N Grand Ave Covina CA 91724-2005 Ph: (626) 859-2089 |
| NPI Number | 1326172404 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 05/01/2024 |
| Certification Date | 05/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326172404 | NPI | - | NPPES |
| 0000056BJ | Medicaid | CA |
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