| Exodus Ab109 Vista | |
|
550 W Vista Way Ste 109 Vista CA 92083-5707 | |
| (760) 305-4635 | |
| (760) 305-4636 |
| Full Name | Exodus Ab109 Vista |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 550 W Vista Way Ste 109, Vista, California |
| Authorized Official Name and Position | Leeann Skorohod (COO) |
| Authorized Official Contact | 3109453350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Exodus Ab109 Vista 9808 Venice Blvd Ste 700 Culver City CA 90232-6824 Ph: (310) 945-3350 | Exodus Ab109 Vista 550 W Vista Way Ste 109 Vista CA 92083-5707 Ph: (760) 305-4635 |
| NPI Number | 1124596291 |
|---|---|
| Provider Enumeration Date | 11/07/2018 |
| Last Update Date | 01/21/2022 |
| Certification Date | 01/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124596291 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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