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900 Fulton Ave Suite 205 Sacramento CA 95825-4500 | |
| (916) 484-3570 | |
| (916) 484-3577 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 900 Fulton Ave, Sacramento, California |
| Authorized Official Name and Position | Lorena Lopez (PROVIDER RELATIONS SUPERVISOR) |
| Authorized Official Contact | 5103377950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1080 Marina Village Pkwy Suite 100 Alameda CA 94501-6427 Ph: (510) 337-7950 | 900 Fulton Ave Suite 205 Sacramento CA 95825-4500 Ph: (916) 484-3570 |
| NPI Number | 1386973972 |
|---|---|
| Provider Enumeration Date | 12/10/2009 |
| Last Update Date | 03/03/2023 |
| Certification Date | 03/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386973972 | NPI | - | NPPES |
| 34FJ | Other | CA | COUNTY MENTAL HEALTH CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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