Organization
CA MENTOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WALSH (CHILD & FAMILY SPECIALIST)
(818) 987-7144
Entity
Organization
Contact information
Practice address
10200 SEPULVEDA BLVD STE 170, MISSION HILLS, CA 91345-3322
(818) 895-9707
Mailing address
761 WARRENDALE ST, SIMI VALLEY, CA 93065-7050
(818) 987-7144
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/19/2021
Last updated
04/16/2024
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