| Ab 109-lompoc | |
|
401 E Cypress Ave Ste 211 Lompoc CA 93436-6806 | |
| (805) 884-6887 | |
| Not Available |
| Full Name | Ab 109-lompoc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 401 E Cypress Ave Ste 211, Lompoc, California |
| Authorized Official Name and Position | Tammy Casiano (QCM COORDINATOR / DESIGNEE) |
| Authorized Official Contact | 8053255905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ab 109-lompoc 300 N San Antonio Rd Santa Barbara CA 93110-1316 Ph: (805) 681-5220 | Ab 109-lompoc 401 E Cypress Ave Ste 211 Lompoc CA 93436-6806 Ph: (805) 884-6887 |
| NPI Number | 1649777889 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 05/03/2023 |
| Certification Date | 05/03/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649777889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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