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Organization
PROTOTYPES OUTPATIENT SERVICES
Active
Organization
PROTOTYPES OUTPATIENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN LATTA-CLARK (DIRECTOR)
(909) 398-4383
Entity
Organization
Contact information
Practice address
831 E ARROW HWY, POMONA, CA 91767-2535
(909) 398-4383
(909) 398-0127
Mailing address
831 E ARROW HWY, POMONA, CA 91767-2535
(909) 398-4383
(909) 398-0127
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
CA
Other
Enumeration date
06/13/2007
Last updated
07/21/2022
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