Organization
DPARTMENT OF BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUGENE CARLSON (CLINIC SUPERVISOR)
(909) 458-9487
Entity
Organization
Contact information
Practice address
1637 E HOLT BLVD, ONTARIO, CA 91761-2107
(909) 458-9487
Mailing address
1637 E HOLT BLVD, ONTARIO, CA 91761-2107
(909) 458-9487
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
OT94
CA
Other
Enumeration date
12/04/2007
Last updated
12/04/2007
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