| NPI | 1649777889 |
|---|---|
| Other Name | AB 109-LOMPOC |
| Entity Type | Organization |
| Authorized Contact | TAMMY CASIANO Qcm Coordinator / Designee 805-325-5905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-05-03 |