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1904 Richland Ave Ceres CA 95307-4562 | |
| (209) 300-8830 | |
| (209) 300-8831 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1904 Richland Ave, Ceres, 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 Parkway Suite 100 Alameda CA 94501-1078 Ph: (510) 337-7950 | 1904 Richland Ave Ceres CA 95307-4562 Ph: (209) 300-8830 |
| NPI Number | 1104284090 |
|---|---|
| Provider Enumeration Date | 02/05/2016 |
| Last Update Date | 03/01/2023 |
| Certification Date | 03/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104284090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |