Healthcare Provider Details

I. General information

NPI: 1558443374
Provider Name (Legal Business Name): LA FAMILIA FAMILY TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 COLLEGE AVE
SANTA ANA CA
92706-2334
US

IV. Provider business mailing address

1905 N. COLLEGE AVE.
SANTA ANA CA
92706
US

V. Phone/Fax

Practice location:
  • Phone: 714-479-0120
  • Fax: 714-479-0153
Mailing address:
  • Phone: 714-479-0120
  • Fax: 714-479-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number30001DN
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number300010DN
License Number StateCA

VIII. Authorized Official

Name: ISABEL C MELLONI
Title or Position: PROJECT DIRECTOR
Credential: MA PSYCHOLOGY
Phone: 714-479-0120