Healthcare Provider Details

I. General information

NPI: 1275959728
Provider Name (Legal Business Name): TIKVAH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22930 CANYON VIEW DR
CORONA CA
92883-9148
US

IV. Provider business mailing address

22930 CANYON VIEW DR
CORONA CA
92883-9148
US

V. Phone/Fax

Practice location:
  • Phone: 951-254-9736
  • Fax: 951-254-9737
Mailing address:
  • Phone: 951-254-9736
  • Fax: 951-254-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-10-7080
License Number StateCA

VIII. Authorized Official

Name: LILLY ALEJANDRA FLORES
Title or Position: OWNER/DIRECTOR
Credential: B.C.B.A.
Phone: 626-757-4940