Healthcare Provider Details

I. General information

NPI: 1720544471
Provider Name (Legal Business Name): LOS ANGELES COMMUNITY MENTAL HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 GOLDEN GATE PKWY
NAPLES FL
34116-7670
US

IV. Provider business mailing address

5240 GOLDEN GATE PKWY
NAPLES FL
34116-7670
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-9510
  • Fax: 239-330-7252
Mailing address:
  • Phone: 239-692-9510
  • Fax: 239-330-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL IGLESIAS
Title or Position: VICE PRESIDENT
Credential:
Phone: 786-357-9076