| So Cal Outpatient | |
|
17671 Irvine Blvd Suite 201 Tustin CA 92780-3178 | |
| (714) 381-0432 | |
| Not Available |
| Full Name | So Cal Outpatient |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 17671 Irvine Blvd, Tustin, California |
| Authorized Official Name and Position | Trina Timanus (PROGRAM MANAGER) |
| Authorized Official Contact | 7143810432 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| So Cal Outpatient 546 S Citron St Anaheim CA 92805-4420 Ph: (714) 381-0432 | So Cal Outpatient 17671 Irvine Blvd Suite 201 Tustin CA 92780-3178 Ph: (714) 381-0432 |
| NPI Number | 1659750974 |
|---|---|
| Provider Enumeration Date | 05/19/2015 |
| Last Update Date | 05/19/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659750974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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