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11835 Carmel Mountain Rd Ste 1304-266 San Diego CA 92128-4609 | |
| (858) 215-4996 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11835 Carmel Mountain Rd Ste 1304-266, San Diego, California |
| Authorized Official Name and Position | Veroniki Usherenko (PRESIDENT) |
| Authorized Official Contact | 8582154996 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11835 Carmel Mountain Rd Ste 1304-266 San Diego CA 92128-4609 Ph: (858) 215-4996 | 11835 Carmel Mountain Rd Ste 1304-266 San Diego CA 92128-4609 Ph: (858) 215-4996 |
| NPI Number | 1992486310 |
|---|---|
| Provider Enumeration Date | 07/27/2023 |
| Last Update Date | 05/15/2024 |
| Certification Date | 05/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992486310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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