Healthcare Provider Details

I. General information

NPI: 1801065503
Provider Name (Legal Business Name): HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE 550
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

9691 KENSINGTON DR
HUNTINGTON BEACH CA
92646-4018
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6767
  • Fax:
Mailing address:
  • Phone: 714-318-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPT31862
License Number StateCA

VIII. Authorized Official

Name: MS. ROSANGELA QUIROZ
Title or Position: MENTAL HEALTH SPECIALIST
Credential: LPT
Phone: 714-318-9791