Organization
JACK GAINES A PROFESSIONAL CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK W. GAINES M.D. (PRESIDENT)
(818) 981-4030
Entity
Organization
Contact information
Practice address
4833 RUBIO AVE, ENCINO, CA 91436-1118
(818) 981-4030
Mailing address
4833 RUBIO AVE, ENCINO, CA 91436-1118
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
C14269
CA
Other
Enumeration date
04/01/2013
Last updated
04/01/2013
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