| NPI | 1265208086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER GUTIERREZ Provider Relations 909-289-4075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2023-12-01 |