| |
1212 Pico St San Fernando CA 91340-3503 | |
(818) 627-3050 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 1212 Pico St, San Fernando, California |
Authorized Official Name and Position | Quentin O'brien (AMBULATORY NETWORK, CEO) |
Authorized Official Contact | 2132889000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1212 Pico St San Fernando CA 91340-3503 Ph: (818) 627-3050 | 1212 Pico St San Fernando CA 91340-3503 Ph: (818) 627-3050 |
NPI Number | 1558379990 |
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Provider Enumeration Date | 08/03/2006 |
Last Update Date | 06/18/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558379990 | NPI | - | NPPES |
FHC16080F | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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