Organization
PROTOTYPES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA MEDINA SNYDER LCSW (SUPERVISOR II)
(626) 577-2261
Entity
Organization
Contact information
Practice address
2555 E COLORADO BLVD, SUITE 100-101, PASADENA, CA 91107-6622
(626) 577-2261
(626) 577-2543
Mailing address
2555 E COLORADO BLVD, SUITE 100-101, PASADENA, CA 91107-6622
(626) 577-2261
(626) 577-2543
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
11/08/2013
Last updated
11/08/2013
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