| Childrens Bureau Of Southern California - San Gabriel | |
|
1515 W Cameron Ave Ste 350 West Covina CA 91790-2726 | |
| (626) 337-8811 | |
| (626) 856-5653 |
| Full Name | Childrens Bureau Of Southern California - San Gabriel |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1515 W Cameron Ave Ste 350, West Covina, California |
| Authorized Official Name and Position | Leticia H Juarez (QA ADMINISTRATIVE MANAGER) |
| Authorized Official Contact | 2133420150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Bureau Of Southern California - San Gabriel 1515 W Cameron Ave Ste 350 West Covina CA 91790-2726 Ph: (626) 337-8811 | Childrens Bureau Of Southern California - San Gabriel 1515 W Cameron Ave Ste 350 West Covina CA 91790-2726 Ph: (626) 337-8811 |
| NPI Number | 1700912557 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700912557 | NPI | - | NPPES |
| 00668 | Other | CA | DMH LEGAL ENITITY NUMBER |
| 7302A | Other | CA | DMH REPORTING UNIT |
| 00007302 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Primary |
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