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Organization
S.T.A.R.T NEURODEVELOPMENT ASSESSMENT AND TREATMENT CENTER
Active
Organization
S.T.A.R.T NEURODEVELOPMENT ASSESSMENT AND TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM LAKES PHD (EXECUTIVE DIRECTOR)
(909) 891-1880
Entity
Organization
Contact information
Practice address
164 W HOSPITALITY LN STE 3, SAN BERNARDINO, CA 92408-3328
(909) 891-1880
Mailing address
13852 BLUEGRASS PL, VICTORVILLE, CA 92392-5533
(760) 245-8031
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
42378
CA
Other
Enumeration date
03/28/2007
Last updated
06/26/2008
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