Healthcare Provider Details

I. General information

NPI: 1780028274
Provider Name (Legal Business Name): ADOLESCENT GUIDANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MARKET PL # 194
SAN RAMON CA
94583-4743
US

IV. Provider business mailing address

231 MARKET PL # 194
SAN RAMON CA
94583-4743
US

V. Phone/Fax

Practice location:
  • Phone: 877-700-3300
  • Fax: 925-830-8720
Mailing address:
  • Phone: 877-700-3300
  • Fax: 925-830-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM LOPEZ
Title or Position: OWNER
Credential:
Phone: 877-700-3300