| N/a | |
|
9267 Greenback Ln B98 Orangevale CA 95662-4863 | |
| (916) 505-9151 | |
| (916) 988-7864 |
| Full Name | N/a |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 9267 Greenback Ln, Orangevale, California |
| Authorized Official Name and Position | Cyrus Moazam (OWNER) |
| Authorized Official Contact | 9165059151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 9267 Greenback Ln B-98 Orangevale CA 95662-4863 Ph: (916) 505-9151 | N/a 9267 Greenback Ln B98 Orangevale CA 95662-4863 Ph: (916) 505-9151 |
| NPI Number | 1366787269 |
|---|---|
| Provider Enumeration Date | 12/03/2012 |
| Last Update Date | 12/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366787269 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | PSY13748 (California) | Primary |
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