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28490 Avenue Stanford Ste 300 Santa Clarita CA 91355-0945 | |
| (661) 295-2130 | |
| (661) 775-7566 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 28490 Avenue Stanford Ste 300, Santa Clarita, 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 | 28490 Avenue Stanford Ste 300 Santa Clarita CA 91355-0945 Ph: (661) 295-2130 |
| NPI Number | 1972517225 |
|---|---|
| Provider Enumeration Date | 07/29/2006 |
| Last Update Date | 07/27/2022 |
| Certification Date | 07/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972517225 | NPI | - | NPPES |
| 7559 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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