Healthcare Provider Details

I. General information

NPI: 1174984579
Provider Name (Legal Business Name): THE GARY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 17TH ST,
SANTA ANA CA
92705
US

IV. Provider business mailing address

341 S. HILLCREST ST
LA HABRA CA
90631
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-0400
  • Fax:
Mailing address:
  • Phone: 562-691-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: RAMONA ROBERTS
Title or Position: INTERN
Credential:
Phone: 714-542-0400