Organization
EDGAR ONTIVEROS
Active
Other names
Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDGAR RINCON ONTIVEROS SR. (CASE MANAGER HISPANIC OUTREACH)
17072634338
Entity
Organization
Contact information
Practice address
15204 LAKESHORE DR, CLEARLAKE, CA 95422-8107
(170) 726-3433
(170) 726-3433
Mailing address
15204 LAKESHORE DR, CLEARLAKE, CA 95422-8107
(170) 726-3433
(170) 726-3433
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
07/27/2011
Last updated
07/27/2011
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