Organization
BHRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNICO ANDREW MAGANA RADT (CLINICAL SERVICE TECHNICIAN)
(209) 247-0735
Entity
Organization
Contact information
Practice address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 525-7411
Mailing address
1904 RICHLAND AVE, CERES, CA 95307-4562
(209) 525-7411
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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