Organization
TELECARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STACEY MAX NIJST I9910608 (PERSONAL SERVICE COORDINATOR)
(714) 226-9888
Entity
Organization
Contact information
Practice address
2569 W WOODLAND DR, ANAHEIM, CA 92801-2608
(714) 226-9888
(714) 226-9887
Mailing address
2569 W WOODLAND DR, ANAHEIM, CA 92801-2608
(714) 226-9888
(714) 226-9887
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
I9910608
CA
Other
Enumeration date
08/01/2008
Last updated
08/01/2008
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