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400 S Melrose Dr Ste 204 Vista CA 92081-6632 | |
| (760) 295-0547 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 400 S Melrose Dr Ste 204, Vista, California |
| Authorized Official Name and Position | Margaret Iwanaga Penrose (PRESIDENT AND CEO) |
| Authorized Official Contact | 6192326454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1031 25th St San Diego CA 92102-2194 Ph: (619) 232-6454 | 400 S Melrose Dr Ste 204 Vista CA 92081-6632 Ph: (760) 295-0547 |
| NPI Number | 1871101089 |
|---|---|
| Provider Enumeration Date | 07/14/2020 |
| Last Update Date | 07/15/2020 |
| Certification Date | 07/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871101089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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