Organization
MONTE NIDO LAKE VISTA, LLC
Active
Parent organization
MONTE NIDO LAKE VISTA, LLC
Other names
Clementine Malibu Lake
Organization subpart
Yes
Provider details
NPI number
Legal business name
MONTE NIDO LAKE VISTA, LLC
Authorized official
MR. MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
(305) 663-1876
Entity
Organization
Contact information
Practice address
29470 LAKE VISTA DR, AGOURA HILLS, CA 91301-2818
(747) 212-5021
(818) 575-7327
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
(786) 359-4485
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/03/2017
Last updated
05/27/2020
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