| West Valley Fast | |
|
9478 Etiwanda Ave Rancho Cucamonga CA 91739-9662 | |
| (909) 382-3080 | |
| (909) 382-3105 |
| Full Name | West Valley Fast |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 9478 Etiwanda Ave, Rancho Cucamonga, California |
| Authorized Official Name and Position | Michael J Day (BUSINESS APPLICATION MANAGER) |
| Authorized Official Contact | 9093823080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Valley Fast 268 W Hospitality Ln Suite 400 San Bernardino CA 92415-0001 Ph: (909) 382-3080 | West Valley Fast 9478 Etiwanda Ave Rancho Cucamonga CA 91739-9662 Ph: (909) 382-3080 |
| NPI Number | 1669681961 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 07/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669681961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | ZZZ74743Z (California) | Primary |
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