Organization
OC TEEN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONAH BAUTISTA (OFFICE MANAGER)
(714) 716-5044
Entity
Organization
Contact information
Practice address
3188 AIRWAY AVE STE L, COSTA MESA, CA 92626-4652
(800) 478-0233
Mailing address
3188 AIRWAY AVE STE L, COSTA MESA, CA 92626-4652
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/09/2021
Last updated
03/07/2024
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