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11240 Magnolia Blvd Ste 204 North Hollywood CA 91601-3975 | |
| (818) 359-9408 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 11240 Magnolia Blvd Ste 204, North Hollywood, California |
| Authorized Official Name and Position | Hugo Mauricio Soto (VP) |
| Authorized Official Contact | 8183599408 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11240 Magnolia Blvd Ste 204 North Hollywood CA 91601-3975 Ph: () - | 11240 Magnolia Blvd Ste 204 North Hollywood CA 91601-3975 Ph: (818) 359-9408 |
| NPI Number | 1386342400 |
|---|---|
| Provider Enumeration Date | 02/17/2023 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386342400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
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