Healthcare Provider Details

I. General information

NPI: 1992822621
Provider Name (Legal Business Name): SAN GABRIEL CHILDREN'S CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N GRAND AVE
COVINA CA
91724-2005
US

IV. Provider business mailing address

13435 MULBERRY DR APT 16
WHITTIER CA
90605-4651
US

V. Phone/Fax

Practice location:
  • Phone: 626-859-2089
  • Fax:
Mailing address:
  • Phone: 562-698-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICTE CAJERO
Title or Position: SOCIAL WORKER
Credential:
Phone: 626-859-2089