Full Name | |
---|---|
Speciality | Community/behavioral Health |
Location | 350 Lakeview Ave, Tahoma, California |
Authorized Official Name and Position | Angela Mcmahon (CONSULTANT) |
Authorized Official Contact | 6198717345 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
350 Lakeview Ave Tahoma CA 96142 Ph: (619) 871-7345 | 350 Lakeview Ave Tahoma CA 96142 Ph: (619) 871-7345 |
NPI Number | 1730600917 |
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Provider Enumeration Date | 06/28/2017 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730600917 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |