| |
337 W Mission Ave Escondido CA 92025-1729 | |
(760) 745-0281 | |
Not Available |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 337 W Mission Ave, Escondido, California |
Authorized Official Name and Position | Jack Farmer (CAO) |
Authorized Official Contact | 6192750822 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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500 La Terraza Blvd Ste 117 Escondido CA 92025-3875 Ph: () - | 337 W Mission Ave Escondido CA 92025-1729 Ph: (760) 745-0281 |
NPI Number | 1659895340 |
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Provider Enumeration Date | 08/03/2017 |
Last Update Date | 02/23/2021 |
Certification Date | 02/23/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659895340 | NPI | - | NPPES |
37Q9 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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