Organization
ST VINCENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA LOPEZ (FAMILY SPECIALIST)
(415) 507-2000
Entity
Organization
Contact information
Practice address
1 SAINT VINCENTS DR, SAN RAFAEL, CA 94903-1504
(415) 507-2000
Mailing address
154 IRIS RD, HERCULES, CA 94547-1215
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/05/2011
Last updated
04/05/2011
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