MEDICARE: MEXICAN AMERICAN ADDICTION PROGRAM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	340004CN	CA
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	340004CN	CA

General Provider Information

NPI Number	:	1689814592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEXICAN AMERICAN ADDICTION PROGRAM, INC.

Provider Business Mailing Address
First Line	:	4241 FLORIN RD
Second Line	:	SUITE 65
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2535
Country	:	US
Telephone Number	:	916-394-2323
Fax Number	:	916-394-2480

Provider Business Practice Location Address
First Line	:	3612 MADISON AVE
Second Line	:	SUITES 29
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-5068
Country	:	US
Telephone Number	:	916-338-6835
Fax Number	:	916-339-1340

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. PAUL CRUZ
Credential	:
Telephone Number	:	916-394-3481

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/19/2014

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