Basic Information
| Provider Information | |||||||||
| NPI: | 1801065503 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH CARE AGENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9691 KENSINGTON DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926464018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143189791 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 W 5TH ST STE 550 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144806767 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2008 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | QUIROZ | ||||||||
| AuthorizedOfficialFirstName: | ROSANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7143189791 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | PT31862 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.