Organization
MONTE NIDO LAKE VISTA, LLC
Active
Other names
Clementine Orange County
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
(305) 663-1876
Entity
Organization
Contact information
Practice address
17059 EL CAJON AVE, YORBA LINDA, CA 92886-2220
(657) 363-4633
(714) 961-6052
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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