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Organization
OUTREACH NATION CLINICS
Active
Organization
OUTREACH NATION CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KHALIDA KHANUM (PROGRAM DIRECTOR)
(909) 825-8080
Entity
Organization
Contact information
Practice address
9375 ARCHIBALD AVE STE 107, RANCHO CUCAMONGA, CA 91730-5728
(909) 825-8080
(909) 360-1550
Mailing address
9375 ARCHIBALD AVE STE 107, RANCHO CUCAMONGA, CA 91730-5728
(909) 825-8080
(909) 360-1550
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
08/17/2020
Last updated
08/17/2020
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