Healthcare Provider Details

I. General information

NPI: 1770224222
Provider Name (Legal Business Name): FOUR SQUARE CLINICALS OF CALIFORNIA A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N CLINE COURT
PLACENTIA CA
92870
US

IV. Provider business mailing address

650 N ROSE DRIVE SUITE 472
PLACENTIA CA
92870
US

V. Phone/Fax

Practice location:
  • Phone: 714-345-6944
  • Fax:
Mailing address:
  • Phone: 714-345-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEVEN HUERTA
Title or Position: CLINICAL OPERATIONS DIRECTOR
Credential: DNP, PMHNP-BC
Phone: 714-345-6944