Organization
INDIVIDUAL
Active
Other names
individual
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MABEL VASQUEZ (INTERN)
(626) 428-6916
Entity
Organization
Contact information
Practice address
12966 EUCLID ST, SUITE 280, GARDEN GROVE, CA 92840-5200
(714) 823-4770
(714) 823-4777
Mailing address
12966 EUCLID ST, SUITE 280, GARDEN GROVE, CA 92840-5200
(714) 823-4770
(714) 823-4777
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/24/2014
Last updated
02/24/2014
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