Organization
A MIRACLE PLACE INC
Active
Organization
A MIRACLE PLACE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMELDA LENZ (LICENSEE)
(310) 408-5620
Entity
Organization
Contact information
Practice address
12674 HOOVER ST, GARDEN GROVE, CA 92841-4173
(310) 408-5620
Mailing address
12674 HOOVER ST, GARDEN GROVE, CA 92841-4173
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/04/2023
Last updated
09/04/2023
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